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Open Access Highly Accessed Research article

Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis

Michael Sand1*, Marcos Gelos1, Falk G Bechara2, Daniel Sand3, Till H Wiese4, Lars Steinstraesser5 and Benno Mann1

Author affiliations

1 Department of General and Visceral Surgery, Augusta Krankenanstalt, Academic Teaching Hospital of the Ruhr-University Bochum, Germany

2 Department of Dermatology and Allergology, Ruhr-University Bochum, Germany

3 Department of Physiological Science, University of California, Los Angeles, USA

4 Department of Radiology, Augusta Krankenanstalt, Academic Teaching Hospital of the Ruhr-University Bochum, Germany

5 Department of Plastic Surgery, Ruhr-University Bochum, Germany

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Citation and License

BMC Surgery 2007, 7:11  doi:10.1186/1471-2482-7-11

Published: 1 July 2007

Abstract

Background

Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology. It can mimick diverticulitis or appendicitis on clinical exam. The diagnosis of EA is very infrequent, due in part to low or absent awareness among general surgeons. The objective of this work was to review the authors' experience and describe the clinical presentation of EA.

Methods

All patients diagnosed with EA between January 2004 and December 2006 at an urban surgical emergency room were retrospectively reviewed by two authors in order to share the authors' experience with this rare diagnosis. The operations were performed by two surgeons. Pathological examinations of specimens were performed by a single pathologist. A review of clinical presentation is additionally undertaken.

Results

Ten patients (3 females and 7 males, average age: 44.6 years, range: 27–76 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 80 %) and right (2 patients, 20%) lower quadrant. All patients were afebrile, and with the exception of one patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.2 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Treatment was laparoscopic excision (n = 8), excision via conventional laparotomy (n = 1) and conservative therapy (n = 1).

Conclusion

In patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. Although infrequent up to date, with the increase of primary abdominal CT scans and ultrasound EA may well be diagnosed more frequently in the future.