Epiplolic Apendagitis: A Diagnosis In Disuse Volume 5 - Issue 1
Pedro Nogarotto Cembranel*
Medical Sciences Course, Health Sciences School, Faculdade Ceres (FACERES), Brazila
Received: March 05, 2020; Published: March 12, 2020
*Corresponding author: Pedro Nogarotto Cembranel, Medical Sciences Course, Health Sciences School, Faculdade Ceres (FACERES),
São José do Rio Preto, SP, Brazil
Introduction: Epiploic appendagitis (EA) is an unusual, benign and self-limited clinical condition. The diagnosis is made
by abdominal computed tomography (CT) and the treatment is conservative. The wrong diagnosis can lead to hospitalizations,
antibiotics and unnecessary surgical intervention.
Case report: Female patient, 38 years old, with abdominal pain in the left iliac fossa for 4 days. Laboratory exams with no
abnormalities, and abdominal tomography (CT) showed smearing of the anti-messenteric border and thickening of the adjacent
fascia. The diagnostic hypothesis of EA was made, analgesic and anti-inflammatory prescribed for home treatment, with complete
remission of the condition in 7 days.
Discussion and conclusion of the case: EA is a rare entity with low incidence, however it should be considered as a diagnostic
hypothesis when it comes to acute abdomen in the emergency. The diagnosis of early EA aims to avoid the use of medications and
unnecessary surgical intervention.
The omental appendages are projections of the outer surface
of the colon, filled with fat, covered with serosa and projecting into
the peritoneal cavity. Epiploic appendagitis (EA) is an unusual,
benign and self-limiting clinical condition [1]. It results from the
spontaneous venous torsion or thrombosis of the veins that drain
the epploic appendages [2]. It manifests as acute abdominal pain.
The diagnosis is made by computed tomography (CT) of the
abdomen and the treatment is conservative. The wrong diagnosis
can lead to hospitalizations, antibiotics and unnecessary surgical
intervention [3].
A 38-year-old female patient arrives at the emergency
department complaining of continuous colic abdominal pain
associated with vomiting and diarrhea for 4 days. She denies fever
and urinary disorders. Upon examination, the abdomen was painful
on palpation of the lower floor, especially in the left iliac fossa, with
reduced hydro-air noises. Laboratory tests including blood count
and urine tests were normal. Abdominal CT showed smearing of the anti-messenteric border and thickening of the adjacent fascia
(Figure 1), with a diagnostic hypothesis of EA.
Figure 1: CT scan of the abdomen with an oval lesion (fat
density) located in the left iliac fossa.
Prescribed analgesics and anti-inflammatory drugs for
outpatient treatment with favorable evolution, with total remission
of symptoms in 7 days.
Approximately 50 to 100 epiploic resources are present
throughout the colon, with predominance in the transverse and
sigmoid colon, ranging from 0.5 to 5 cm [1]. EA is a benign clinical
condition, which occurs secondarily in spontaneous venous torsion
or thrombosis of the veins that drain the epploid appendages [1-2].
The usual clinic is for acute abdominal pain located in the
lower left quadrant, which may mimic acute abdomen, leading to
an incorrect diagnosis of appendicitis or acute diverticulitis. There
may be an increase in leukocytes in the blood and an increase in the
erythrocyte sedimentation rate, without urinary changes [4].
The diagnosis is made through abdominal CT, with a finding of
paracolic, oval mass, from 1 to 5 cm, with fat density, accompanied
by thickening of the peritoneal lining and attenuation of
periapendicular fat [5-6].
Treatment is conservative, on an outpatient basis and dispenses
with the use of antibiotics or surgical treatment. It consists of the
administration of analgesics and anti-inflammatory drugs, with
complete improvement of symptoms [7-8].
EA is a rare entity with low incidence, but it should be
considered as a diagnostic hypothesis when it comes to acute abdomen in the emergency. The diagnosis of early EA aims to avoid
the use of medications and unnecessary surgical intervention.