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Primary epiploic appendagitis: Reconciling CT and clinical challenges

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Abstract

Objectives

Our aim was to explain the spectrum of clinical and CT findings in 18 patients with acute epiploic appendagitis.

Methods and Materials

We reviewed the clinical records and CT pictures of 18 consecutive patients seen in Nejran Armed Forces Hospital, Nejran, Kingdom of Saudi Arabia and Sohag University Hospital, Sohag, Egypt between July 2006 and June 2013 with a diagnosis of primary epiploic appendagitis.

Results

The age ranged between 22 and 64 years old with a mean of 44.3. Males were affected in 72 % of cases. Eleven patients had acute pain in left lower quadrant. Nausea and vomiting were encountered in four patients. No fever was recorded in all cases. Leukocytosis was found in four patients and C-reactive protein (CRP) was high in five. CT scan diagnosed primary epiploic appendagitis (PEA) in 15 patients, while 3 patients were diagnosed intraoperatively. The left colon was affected in 11 patients. All patients except one had a central fatty core surrounded by inflammation with size ranging between 1.5 and 3.5 cm in length. Fifteen patients were treated conservatively, and three cases underwent surgical exploration. Ten patients (55.5 %) completed the follow up schedule. Complete resolution was noted in three patients at 2 weeks, in six patients at 3 months, and only one patient had residual changes at 6 months.

Conclusion

PEA is a challenging clinical diagnosis, and CT scan is extremely necessary in diagnosing this disease accurately. The awareness of the surgeons concerning this rare occasion will avoid unnecessary hospital admission and operative treatment.

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Conflict of interest

JS, HAM, AME, FA, and SA all declare that they have no conflict of interest.

Ethical statement

The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning Informed Consent as shown on Springer.com.

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Authors and Affiliations

  1. Department of Radiology, Nejran Armed Forces Hospital, Alfahd Street, Nejran, 1002, Saudi Arabia

    Jamel Saad

  2. Deparment of Surgery, Nejran Armed Forces Hospital, Alfahd Street, Nejran, 1002, Saudi Arabia

    Hussein Ali Mustafa

  3. Deparment of Surgey, Sohag Hospital, Sohag hospital, Sohag, Egypt

    Asem Mohamed Elsani

  4. Deparment of Internal Medicine, Nejran Armed Forces Hospital, Alfahd Street, Nejran, 1002, Saudi Arabia

    Fawaz Alharbi

  5. Department of Family Medicine, Nejran Armed Forces Hospital, Alfahd Street, Nejran, 1002, Saudi Arabia

    Saad Alghamdi

Authors
  1. Jamel Saad
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  2. Hussein Ali Mustafa
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  3. Asem Mohamed Elsani
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  4. Fawaz Alharbi
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  5. Saad Alghamdi
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Corresponding author

Correspondence to Jamel Saad.

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Saad, J., Mustafa, H.A., Elsani, A.M. et al. Primary epiploic appendagitis: Reconciling CT and clinical challenges. Indian J Gastroenterol 33, 420–426 (2014). https://doi.org/10.1007/s12664-014-0466-y

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  • DOI: https://doi.org/10.1007/s12664-014-0466-y

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