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Acevedo-Castillo CD, Macias-Cruz HM, Ramirez-Cisneros A, Bautista-Coronado UA, Moran-Guerrero JA, Guzman EA. Epiploic Appendagitis: Systematic Review of a Distinctive Pathology. Am Surg 2024:31348241256062. [PMID: 38756087 DOI: 10.1177/00031348241256062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Introduction: Epiploic appendagitis (EA) is an essential cause of abdominal pain that can be confused with more typical causes such as acute diverticulitis and appendicitis. Epiploic appendagitis accounts for 1% of all cases of abdominal pain in adults. The scarcity of information has limited its recognition as an essential nonsurgical cause of acute abdominal pain.Methods: We performed a systematic review of all EA cases published. We searched Scopus, Medline, Web of Science, and Google Scholar to retrieve all available studies from January 2000 to November 2023.Results: 196 case reports and case series were analyzed, with 371 patients with EA included. The mean age at the time of diagnosis was 39 years. Most patients were male (59%). The primary presenting symptoms were pain (100%), tenderness (59.5%), and rebound tenderness (27.4%). The left abdomen was the most common localization of pain (53%). The most frequently identified differential diagnoses were acute appendicitis (26.4%) and acute diverticulitis (16.1%). Most patients (53%) were treated conservatively, and 98 (26.4%) underwent surgical treatment. A significant difference in the choice of treatment was found for signs and symptoms such as rebound tenderness, nausea, anorexia, and diarrhea.Conclusions: Acute EA is an essential clinical condition of rare occurrence that might present a diagnostic challenge, as it can masquerade as another acute abdominal pain etiology. The optimal management of EA is conservative, so a higher recognition by surgeons and emergency physicians is essential to avoid unnecessary surgical interventions and their associated consequences.
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Affiliation(s)
| | - Hannia M Macias-Cruz
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, México
| | | | | | - Jose A Moran-Guerrero
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, México
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2
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El-Menyar A, Naqvi SGA, Al-Yahri O, Abusal AM, Al-Shaikhli A, Sajid S, Abdelrahman H, Kloub AG, Ibnas M, Latifi R, Toble YMR, Al-Thani H. Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases. World J Surg 2024. [PMID: 38558004 DOI: 10.1002/wjs.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Syed G A Naqvi
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Omer Al-Yahri
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Sadia Sajid
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad G Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Muhamed Ibnas
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Kosova College of Surgeons, Prishtina, Kosova, and University of Arizona, Tucson, Arizona, USA
| | - Yasser M R Toble
- Department of Anesthesiology and Pain Management, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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3
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Lahham EE, Alsalah QA, Alsahouri MI, Ghweir A, AlQadi M, Sarhan N. A rare case of epiploic appendages infarction within an incisional hernia: a usual complain of unusual cause. J Surg Case Rep 2023; 2023:rjad483. [PMID: 37621959 PMCID: PMC10447079 DOI: 10.1093/jscr/rjad483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023] Open
Abstract
Epiploic appendagitis (EA) is an uncommon condition caused by infarction of epiploic appendages "small fat outpouchings present on the outside of the colon wall" because of torsion or thrombosis of the main draining vein. It is sometimes misdiagnosed as diverticulitis or appendicitis. Lab tests usually are normal, and the diagnosis is mainly by computerized tomography (CT) scan. Treatment is conservative as it is a self-limited condition, and the symptoms will resolve spontaneously within 2 weeks. However, surgical appendage removal could be necessary if symptoms increase or continue. Here, we report our experience with a 21-year-old male patient, who presented with a 1-day duration of localized right lower quadrant (RLQ) abdominal pain within 18*10 cm incisional hernia, imaging revealed signs of epiploic appendages infarction within the huge incisional hernia. This case describes an atypical scenario for EA, which was successfully managed with surgery. The final pathology report confirms the diagnosis.
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Affiliation(s)
- Elias Edward Lahham
- Department of Radiation Oncology, Augusta Victoria Hospital, East Jerusalem, Palestinian Authority 9511208, Palestine
| | - Qusai A Alsalah
- Faculty of Medicine, Palestine Polytechnic University, Hebron 150, Palestine
| | | | - Abdalrazeq Ghweir
- Faculty of Medicine, Palestine Polytechnic University, Hebron 150, Palestine
| | - Mohammad AlQadi
- General Surgery Department, Beit-Jala Hospital, Bethlehem 4322, Palestine
| | - Nafez Sarhan
- Palestine Ahliya University, Bethlehem 4322, Palestine
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4
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Abramov D, Daniel R, Pellegrini JR, Rivera AP. Bacteremia Secondary to Epiploic Appendagitis (EA). Cureus 2023; 15:e41648. [PMID: 37565111 PMCID: PMC10411651 DOI: 10.7759/cureus.41648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Epiploic appendages are fat-filled sacs that are generally located along the surface of the large intestine. In most cases, epiploic appendagitis (EA) is described as an ischemic infarction of an epiploic appendage as the result of torsion or spontaneous thrombosis of the central draining vein of the epiploic appendage. The patient described in this report presented with a sudden onset of diffuse abdominal pain, nausea, and fever. CT scan of the abdomen and pelvis with oral contrast revealed EA of the sigmoid colon. Along the course of the admission, the patient became septic with blood cultures growing E. coli. In this case, we present a rare presentation of E. coli sepsis in the setting of EA, a usually uncomplicated and self-resolving presentation of abdominal pain.
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Affiliation(s)
- Daniella Abramov
- Plastic Surgery and General Surgery, New York Institute of Technology College of Osteopathic Medicine, New York, USA
| | - Rachel Daniel
- Internal Medicine, American University of the Caribbean School of Medicine, East Meadows, USA
| | | | - Ana P Rivera
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
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5
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Ito M, Sato T, Nagai T. Epiploic Appendagitis: A Rare Cause of Acute Abdominal Pain. JMA J 2023; 6:209-210. [PMID: 37179725 PMCID: PMC10169279 DOI: 10.31662/jmaj.2022-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/25/2022] [Indexed: 05/15/2023] Open
Affiliation(s)
- Masahiro Ito
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Niigata, Japan
- Nagaoka Sutoku University, Niigata, Japan
| | - Toshiki Sato
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Niigata, Japan
| | - Tsuneo Nagai
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Niigata, Japan
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6
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Muacevic A, Adler JR, Hon K, Lomiguen CM, McBride T. Epiploic Appendagitis Mimicking Acute Appendicitis: An Osteopathic Case Report. Cureus 2022; 14:e32499. [PMID: 36654652 PMCID: PMC9840429 DOI: 10.7759/cureus.32499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Acute epiploic appendagitis is a rare cause of abdominal pain, often misdiagnosed as acute appendicitis or diverticulitis given similar clinical presentation and findings. The treatment is supportive care and is typically self-limited. The osteopathic structural exam can give insight into pathology and in this case, was suggestive of a non-appendiceal origin of her pain, in which emergent surgery could be avoided. Requiring computerized tomography to identify, acute epiploic appendagitis is a rare cause of abdominal pain and should be considered in the differential diagnosis.
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7
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Khafaji RA, Ghandourah HS, Altamimi SK, Alwarthan AA, Alhabib RA, Alaiyar MN, Alomar IA, Alayshan MI, Almasoudi MS, Jaml Allil HA, Munshi SZ, Aljamri SK, Bagadeem BS, Attar MS, Al-Hawaj F. Epiploic Appendagitis Clinically Masquerading as an Acute Diverticulitis. Cureus 2021; 13:e20188. [PMID: 35004011 PMCID: PMC8727498 DOI: 10.7759/cureus.20188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/22/2022] Open
Abstract
Acute diverticulitis is a prevalent surgical condition that typically presents with lower abdominal pain and tenderness. However, the clinical and laboratory findings of diverticulitis are non-specific and other conditions may give similar manifestations. We present the case of a middle-aged woman with a left lower quadrant abdominal pain and fever of three days duration. On examination, she had tachycardia and localized tenderness in the left iliac fossa with rebound tenderness. There were no signs of peritonitis, including the rigid abdomen and decreased bowel sounds. The laboratory findings were suggestive of an inflammatory or infectious process. A computed tomography scan of the abdomen demonstrated a fat-density lesion anterior to the descending colon representing epiploic appendagitis. The patient was managed conservatively with non-steroidal anti-inflammatory drugs (lornoxicam 8 mg). The patient experienced gradual improvement and was discharged after four days of hospitalization. No surgical intervention was needed. The case highlighted the importance of considering epiploic appendagitis in the differential diagnosis of acute diverticulitis. An accurate diagnosis will prevent the patient from having unnecessary surgeries as conservative management is often sufficient in patients with epiploic appendagitis.
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Affiliation(s)
| | | | | | - Afnan A Alwarthan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | | | | | - Hashem A Jaml Allil
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | | | - Sarah K Aljamri
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Basil S Bagadeem
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Motaz S Attar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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8
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Shelton J, Terry S. CT Imaging Findings of Porcelain Gallbladder and Epiploic Appendagitis: Two Rare Abdominal Pathologies in an Asymptomatic Patient. Cureus 2021; 13:e15578. [PMID: 34277200 PMCID: PMC8272651 DOI: 10.7759/cureus.15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Porcelain gallbladder (PG) and epiploic appendagitis (EA) are rare imaging findings in an asymptomatic patient. The clinical presentation of PG and EA can vary; however, a common presenting complaint is abdominal discomfort. We describe the case of a 54-year-old male with computerized tomography findings consistent with PG and EA. We also performed a review of the literature to understand the etiology, clinical presentation, and diagnosis and treatment options of both PG and EA.
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Affiliation(s)
| | - Shawn Terry
- Trauma & Critical Care Surgery, Wellspan York Hospital, York, USA
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9
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Tan R, Parys S, Watanabe Y. Diagnosis and management of epiploic appendagitis: a single-institution 10-year experience. Pol Przegl Chir 2021; 93:20-24. [PMID: 36169532 DOI: 10.5604/01.3001.0014.8912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
<b>Introduction</b>: Epiploic appendagitis is known to be a benign and self-limiting process, yet optimal management is not well understood. Research focused on the efficacy of treatment in this rare condition may allow future patients diagnosed with epiploic appendagitis to be treated accordingly with the best evidence-based medical practice.<br/><b>Aim</b>: The aim of this study was to investigate the diagnosis, compare management options and follow up epiploic appendagitis. <br><b>Materials and methods</b>: This retrospective study included all patients over 18 years of age who were treated in a large tertiary hospital in the years 2009-2019 with a confirmed diagnosis of epiploic appendagitis and no coexisting acute intra-abdominal pathologies. Patients' health information was recorded and analysed.<br/><b>Results</b>: As many as 78 patients were diagnosed with epiploic appendagitis over a 10-year observation period. A minor male predominance (55%) and a broad range of ages at the moment of diagnosis (18-75) were found, with diabetes (n = 10) being the most common comorbidity in this condition . In the majority of cases, the disease was located in the sigmoid (41%) and descending colon (35%). Diagnosis was primarily based on imaging (computerised tomography 91%, ultrasonography 2.6%). Six percent of patients were diagnosed during surgery and these patients recovered with smaller rates of readmissions and recurrences (P < 0.05). Patients given opioids on discharge were less likely to be readmitted to hospital (P < 0.05), while those given antibiotics had a longer inpatient stay (P < 0.05) with no change in readmission rates (P = 0.78) or recurrence rates (P = 0.48). <br/><b>Discussion</b>: Managing epiploic appendagitis with antibiotics is shown to have no effect on patient outcomes, while opioid use for pain control did not affect the length of hospital stay but it reduced the number of readmissions when compared to simple analgesics alone.
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Affiliation(s)
- Riley Tan
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Simon Parys
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Yuki Watanabe
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
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10
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Zadeh ES, Kindermann J, Dietrich CF, Görg C, Bleyl T, Alhyari A, Trenker C. Clinical Awareness and Acceptance of Sonographically Diagnosed Epiploic Appendagitis (EA): A Retrospective Analysis of EA in a Single Tertiary Academic Referral Center. Ultrasound Int Open 2021; 6:E87-E93. [PMID: 33728395 PMCID: PMC7954640 DOI: 10.1055/a-1371-9359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/24/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose
To describe the clinical awareness and acceptance of ultrasound-diagnosed acute epiploic appendagitis (EA) and their importance to avoid unnecessary therapeutic and imaging measures.
Patients and Methods
The data were obtained of n=54 patients with acute, localized, peritonitic pain and EA diagnosed by B-mode ultrasound and contrast-enhanced ultrasound examination from November 2003 to September 2020. All examinations were performed by a German Society for Ultrasound in Medicine (DEGUM) Level III qualified examiner. Based on documentation by the treating physicians, the clinical awareness and acceptance of EA diagnosis was determined in all patients and compared between subgroups diagnosed before 2013 and from 2013 onwards. In 2013, a local educational training program regarding the diagnosis of and therapy for EA was initiated for physicians.
Results
In all patients, EA was sonographically diagnosed by a DEGUM level III qualified examiner. At enrollment, EA was mentioned as a suspected clinical diagnosis in n=1/54 (1.9%) patient. Furthermore, in n=39/54 (72.2%) cases, the EA was documented and accepted by the treating physicians at the time of patient discharge as the final clinical diagnosis. The clinical acceptance was significantly higher from 2013 onwards compared with before 2013 (p<0.05). Moreover, in n=26/54 (48.1%) patients, unnecessary therapeutic measures were initiated, with no significant difference between pre-2013 and post-2013 numbers (p>0.05).
Conclusion
In our retrospective study, we showed that awareness and acceptance of the disease EA are low. Low diagnostic acceptance of EA by the clinician leads to unnecessary therapeutic and imaging measures and is a general problem related to rare diseases in the healthcare system.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Julia Kindermann
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department of General Internal Medicine, Hirslanden Klinik Beau-Site, Bern, Switzerland
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Tobias Bleyl
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany
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11
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Akubudike JTE, Egigba OF, Kobalava B. Epiploic Appendagitis: A Commonly Overlooked Differential of Acute Abdominal Pain. Cureus 2021; 13:e12807. [PMID: 33628675 PMCID: PMC7894223 DOI: 10.7759/cureus.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Epiploic appendagitis is an unusual and very commonly overlooked source of acute abdominal pain. Its incidence is highest in middle-aged obese males. It presents clinically as a focal lower quadrant abdominal pain, usually in the absence of pyrexia, nausea, vomiting or change in bowel habit, and unremarkable laboratory markers. Due to its vague presentation, epiploic appendagitis may be mistaken for other more severe causes of acute abdominal pain like diverticulitis and appendicitis, thereby causing patients to undergo unwarranted management interventions and hospital stay. Epiploic appendagitis is usually diagnosed through imaging, most commonly computed tomography (CT). This condition is largely self-resolving and can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). Operative intervention is usually employed when symptoms persist or when complications arise. We present a case of epiploic appendagitis in a patient who presented with right lower quadrant pain initially misdiagnosed as acute appendicitis.
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12
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Abstract
Acute epiploic appendagitis is a benign condition caused by inflammation of the epiploic appendages that are serosal lined outpouchings of the colon lying adjacent to the tenia coli. This rare condition has non-specific clinical findings and is frequently misdiagnosed as either acute diverticulitis or acute appendicitis. However, unlike other surgical causes of acute abdomen, epiploic appendagitis is a self-limited condition and resolves with conservative management. CT of the abdomen plays a vital role in diagnosing this condition and excluding other causes of acute abdomen. This case report highlights the importance of being aware of this rare condition and its consideration in the differential diagnosis of acute lower abdominal pain to avoid unnecessary hospitalization and surgery.
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Affiliation(s)
| | - David Lerner
- Department of Radiology: Abdominal Imaging, University of Washington, Seattle, USA
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13
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Uddin AF, Menon G, Menon A, Saad Abdalla Al-Zawi A, Menon J. Epiploic Appendagitis Masquerading as Acute Appendicitis: A Report of Two Cases. Cureus 2020; 12:e10689. [PMID: 33133854 PMCID: PMC7593212 DOI: 10.7759/cureus.10689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Epiploic appendagitis (EA) is a rare clinical entity caused by an inflammatory/ischemic process involving the serosal outpouchings of the colon. Its clinical presentation of acute, localised, lower abdominal pain often mimics more common conditions like diverticulitis or appendicitis. The diagnosis of EA is challenging due to the lack of pathognomic clinical features. The definitive diagnosis primarily relies on cross-sectional imaging modalities like abdominal ultrasound or computed tomography (CT). Being a benign and self-limiting condition, it can be managed conservatively with analgesic and anti-inflammatory drugs. We present two cases to highlight EA as an important differential diagnosis for cases of acute lower abdominal pain, crucial to prevent unnecessary antibiotic therapy and surgical interventions.
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Affiliation(s)
- Aaliya F Uddin
- General Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Gautam Menon
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Chelmsford, GBR
| | | | - Abdalla Saad Abdalla Al-Zawi
- Breast Surgery, Anglia Ruskin University, Chelmsford, GBR.,Breast Surgery, Basildon and Thurrock University Hospital, Basildon, GBR.,General Surgery, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Jay Menon
- Vascular Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
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14
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Trovato P, Simonetti I, Verde F, Lomoro P, Vinci G, Tarotto L, Corvino F, Corvino A. Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques. Pol J Radiol 2020; 85:e178-82. [PMID: 32419882 DOI: 10.5114/pjr.2020.94335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/02/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Acute epiploic appendagitis (EA) is a relatively rare, benign and local inflammatory disease involving the epiploic appendices. Unlike its mimics, EA is generally a self-limiting inflammatory disease and can be treated conservatively. Case presentation A 33-year-old Caucasian man presented to our emergency department with a sever and sharp left iliac fossa pain. He underwent abdominal X-ray, ultrasound (US) and computed tomography (CT) evaluations. Conclusion We illustrate US and CT findings to increase the radiologists’ awareness of this condition and to avoid diagnostic delay and unnecessary use of antibiotics, hospitalization and surgery.
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15
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Yousaf A, Ahmad S, Ghaffar F, Sajid S, Ikram S. Bilateral Epiploic Appendagitis: A Rather Benign but Diagnostically Challenging Cause of Acute Abdominal Pain. Cureus 2020; 12:e7897. [PMID: 32494512 PMCID: PMC7263009 DOI: 10.7759/cureus.7897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Epiploic appendagitis (EA) is a rare and often misdiagnosed cause of acute abdominal pain. It is a benign and self-limited condition but mimics other underlying causes of acute abdominal pain like acute diverticulitis, acute appendicitis, acute cholecystitis, etc. Inaccurate diagnosis can lead to iatrogenic adverse outcomes. To the best of our knowledge, the present report represents the first case of bilateral EA involving both cecum and descending colon. The patient presented with symptoms of bilateral iliac fossa pain. Conservative management and close outpatient follow up resulted in a successful clinical outcome with no recurrence of symptoms. This article illustrates that clinicians and radiologists should include this etiology among differential diagnoses of patients presenting with acute abdominal pain, as it might prevent unnecessary hospitalizations, antibiotic therapy, and unwarranted surgical interventions.
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Affiliation(s)
- Amman Yousaf
- Radiology, Hamad General Hospital, Doha, QAT.,Radiology, Services Institute of Medical Sciences, Lahore, PAK
| | - Soban Ahmad
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Fariha Ghaffar
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Sadia Sajid
- Radiology, Hamad Medical Corporation, Doha, QAT
| | - Sundus Ikram
- General Surgery, Hamad Medical Corporation, Doha, QAT
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16
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Kamr WH, Taman SE, Tawfik AI. Multislice computed tomography evaluation of primary abdominal fat necrosis: a rare cause of acute abdominal pain. Pol J Radiol 2019; 84:e389-96. [PMID: 31969955 DOI: 10.5114/pjr.2019.89441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Abdominal fat necrosis is a rare cause of abdominal acute pain, classified into primary or secondary according to the cause. Primary fat necrosis includes epiploic appendagitis or idiopathic infarction of the greater omentum. This retrospective study focuses on multislice computed tomography (MSCT) findings and diagnosis of primary abdominal fat necrosis as a cause of acute abdomen. Material and methods This was a retrospective study with 20 patients included, presented to emergency room with acute abdominal pain diagnosed as primary fat necrosis. Retrospective evaluation was made of the patients’ clinical data, presentation, CT studies done at the acute stage, and their primary and final diagnosis. Results Twenty patients (eight male and 12 female, mean age 45 years, age range 20-70 years) diagnosed with abdominal fat necrosis (primary omental infarct) on CT imaging between October 2014 and June 2018 were evaluated. Clinically, five patients were suspected to be cholecystitis¸ eight patients as appendicitis, and four patients as diverticulitis. In addition, three patients had renal colic and were suspected to have ureteric stones; they showed suspected areas of abnormal fat density in non-contrast CT of the urinary tract. Idiopathic omental infarctions were detected in 13 patients on CT; all were on the right side. Laparoscopic excision was done for all. The other seven patients had epiploic appendagitis, seen on the left side, treated with conservative management. Conclusions Primary fat necrosis, although rare, can be presented as acute abdomen. MSCT is the main diagnostic tool for diagnosis of omental infraction and differentiation between other causes of acute abdomen.
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Almeida RR, Singh AK, Mansouri M, Spilberg G, Alkasab T, Lev MH. Impact of Radiology Report Wording on Care of Patients With Acute Epiploic Appendagitis. AJR Am J Roentgenol 2019; 212:1265-70. [PMID: 30860892 DOI: 10.2214/AJR.18.20747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the association between the diagnostic certainty expressed by the wording of CT report impressions and subsequent use of standard treatment with analgesics versus nonstandard antibiotic administration in patients with acute epiploic appendagitis (EA). MATERIALS AND METHODS. Demographic, clinical, and radiologic data from a 10-year cohort of patients with acute EA were retrospectively analyzed and correlated with standard treatment with analgesics versus nonstandard treatment with antibiotics. A level of certainty was assigned to the CT report language based on the wording of the impression statements by two radiologists; their interreader agreement was assessed with kappa statistics. Bivariate analyses were performed to correlate all variables with antibiotic administration and to assess for collinearity. Multivariate logistic regression was performed to identify independent predictors of antibiotic use in patients with acute EA. RESULTS. Of 124 patients with CT-diagnosed acute EA, 22% (27/124) received antibiotic treatment. After the CT report impressions were evaluated, 27% (34/124) were categorized as low certainty and 73% (90/124) as high certainty (κ = 0.958, p < 0.001). Multivariate regression was significant (p < 0.001, Nagelkerke R2 = 0.249) and found CT report impressions' level of certainty (odds ratio [OR] = 6.1, p < 0.001) and evaluation in an outpatient clinic rather than an emergency department (ED) (OR = 4.4, p = 0.003) to be independent predictors of antibiotic administration for patients with acute EA. Outpatient presentation was also correlated with age, abdominal pain duration, and left-colonic involvement in the bivariate analysis (all p ≤ 0.01). CONCLUSION. The diagnostic certainty conveyed by the wording of CT report impressions correlated with antibiotic treatment decisions for patients with acute EA. Patients whose report impressions expressed low rather than high certainty were six times more likely to receive antibiotic therapy; patients evaluated at outpatient clinics rather than EDs were four times more likely.
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Tachamo N, Timilsina B, Nazir S, Lohani S. Abdominal pain - learning when not to intervene! J Community Hosp Intern Med Perspect 2016; 6:32960. [PMID: 27987280 PMCID: PMC5161783 DOI: 10.3402/jchimp.v6.32960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/07/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
Epiploic appendagitis (EA) is an uncommon cause of abdominal pain. It is a benign condition but may mimic other serious causes of acute abdomen such as appendicitis, diverticulitis, and gynecological emergency in severe cases. Knowledge of this condition in the differential diagnosis of abdominal pain can save unnecessary hospital admission, antibiotics, and surgery. In this article, we present the case of a 43-year-old female who presented to our hospital with a 2-day history of right lower quadrant abdominal pain and diarrhea. She was diagnosed with EA with computed tomography of abdomen with contrast and was managed conservatively with good outcome.
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Affiliation(s)
- Niranjan Tachamo
- Department of Medicine, Reading Hospital, West Reading, PA, USA;
| | | | - Salik Nazir
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Saroj Lohani
- Department of Medicine, Reading Hospital, West Reading, PA, USA
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Abstract
Acute epiploic appendagitis is a relatively rare cause of lower abdominal pain that clinically mimics other acute abdomen conditions that require surgery such as acute diverticulitis or appendicitis. Here, we report a case of a 50-year-old lady who presented with an unusual lower abdominal pain. Awareness of such a clinical condition with its characteristic imaging findings is important to avoid costly hospitalization, unnecessary antibiotic courses, and the morbidity and mortality associated with surgical procedures.
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Affiliation(s)
- Afnan F Almuhanna
- Department of Surgery, King Fahad University Hospital, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Zeead M Alghamdi
- Department of Radiology, King Fahad University Hospital, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Eiman Alshammari
- Department of Surgery, King Fahad University Hospital, University of Dammam, Dammam, Kingdom of Saudi Arabia
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Maghrebi H, Slama H, Ksantini R, Makni A, Fteriche F, Ayadi S, Rebai W, Daghfous A, Chebbi F, Ammous A, Jouini M, Kacem M, Ben Safta Z. [Primitive epiploic appendagitis : about five cases]. Pan Afr Med J 2015; 20:4. [PMID: 25995801 PMCID: PMC4430162 DOI: 10.11604/pamj.2015.20.4.5509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/18/2014] [Indexed: 11/23/2022] Open
Abstract
La torsion de frange épiploïque (ou appendagite) est une pathologie rare qui survient principalement chez les adultes entre 20 et 50 ans. L'incidence de cette pathologie n'est pas réellement connue et elle varie de 2 à 7% chez les patients hospitalisés pour suspicion d'appendicite ou de sigmoïdite. Nous rapportons cinq cas d'appendagites dont nous précisons les particularités cliniques, radiologiques et thérapeutiques. Il s'agit de 5 patients dont l’âge moyen est de 34.6 ans (24-55). Le sexe ratio est de 1.5. Le principal motif de consultation était un syndrome douloureux de l'abdomen principalement au niveau de la fosse iliaque droite. L'examen abdominal montrait toujours une sensibilité localisée. La fièvre était présente chez 3 patients. Le bilan biologique révèle un syndrome inflammatoire biologique chez trois patients. Les examens complémentaires radiologiques en particulier échographie abdominale et TDM abdominale ont éliminé formellement une urgence chirurgicale et ont évoqué le diagnostic d'appendagite dans trois cas. Trois patients ont bénéficié d'une cœlioscopie diagnostique confirmant le diagnostic d'appendagite. L’évolution était favorable chez tous les patients. Les appendagites épiploïques primitives sont des étiologies rares et sous-estimées de syndrome abdominal aigu. Le diagnostic peut être affirmé par imagerie notamment avec le scanner hélicoïdal injecté, permettant d'instaurer ainsi un traitement médical premier et d’éviter un traitement chirurgical et des hospitalisations excessives.
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Affiliation(s)
- Houcine Maghrebi
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Helmi Slama
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Rachid Ksantini
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Amine Makni
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Fadhel Fteriche
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Sofiene Ayadi
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Wael Rebai
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Amine Daghfous
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Faouzi Chebbi
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Adel Ammous
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Mohamed Jouini
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Montassar Kacem
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
| | - Zoubeir Ben Safta
- Faculté El Manar, Faculté de Médecine de Tunis, Service de Chirurgie A, Hôpital La Rabta, Tunis, Tunisie
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Abstract
Epiploic appendagitis is a little-diagnosed condition capable of mimicking various pathologies. Here, we present a case presenting as acute pancreatitis.
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Affiliation(s)
| | - Peter Thurley
- Department of Radiology, Royal Derby Hospital, Derby, UK
| | - Altaf Awan
- Department of General Surgery, Royal Derby Hospital, Derby, UK
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Rashid A, Nazir S, Hakim SY, Chalkoo MA. Epiploic appendagitis of caecum: a diagnostic dilemma. Ger Med Sci 2012; 10:Doc14. [PMID: 23255877 PMCID: PMC3525882 DOI: 10.3205/000165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/04/2012] [Indexed: 12/18/2022]
Abstract
Epiploic appendagitis is a rare cause of acute abdomen. Depending on the site of occurrence, it can mimic any cause of acute abdomen or disease of the colon and caecal appendix; making its preoperative diagnosis very difficult. We present here a case of a 7-year-old boy misdiagnosed preoperatively as acute appendicitis and later on, upon surgical exploration, found to have caecal appendagitis. The affected epiploic appendage was removed and the patient had an uneventful recovery. We also review the relevant literature and discuss the measures to overcome this diagnostic dilemma. General surgeons should be aware of this self-limiting disease and consider it as a differential diagnosis of acute abdomen.
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Affiliation(s)
- Arshad Rashid
- Department of Surgery, Government Medical College, Srinagar, India.
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Abstract
We report the case of a 23 year-old obese female, with previously diagnosed situs inversus below the diaphragm, who presented with severe left upper quadrant abdominal pain. The patient was believed to have a surgical indication, possibly appendicitis or diverticulitis, and had an emergent abdominal Computed Tomography (CT) scan. The CT was interpreted as epiploic appendagitis with no signs of appendicitis. Epiploic appendagitis is a rare cause of acute abdominal pain, which involves the torsion and eventual necrosis of one of the epiploic appendages. This case was complicated by the fact that the patient had situs inversus below the diaphragm, which made it difficult to relate her localized abdominal pain to the correct anatomic area. The diagnosis allowed the patient to avoid invasive surgery and instead opt for conservative medical management. The utilization of radiologic imaging is of utmost importance in diagnosing this condition, which has characteristic findings on CT, US, and MR, all of which is discussed in this article.
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Affiliation(s)
- Christopher Ryen
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
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Ballas K, Kontoulis T, Skouras C, Triantafyllou A, Symeonidis N, Pavlidis T, Marakis G, Sakadamis A. Unusual findings in inguinal hernia surgery: report of 6 rare cases. Hippokratia 2009; 13:169-171. [PMID: 19918306 PMCID: PMC2765295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND AIM To present our experience with unexpected findings during hernia surgery, either unusual hernial contents or pathologic entities, like neoplastic masses, masquerading as a hernia. PATIENTS AND METHODS We studied retrospectively 856 patients with inguinal hernia who were admitted to our surgical department over a 9-year period. In addition, our study included patients complaining of inguinal protrusion, even without a definitive diagnosis of inguinal hernia upon admission. RESULTS Five patients presented with unusual hernial contents. Three of them had a vermiform appendix in their sac. Acute appendicitis (Amyands hernia) was found in only one case. One patient had epiploic appendagitis related with a groin hernia. Moreover, an adult woman was diagnosed with ovarian and tubal inguinal hernia. Finally, we report a case of a massive extratesticular intrascrotal lipoma, initially misdiagnosed as a scrotal hernia. CONCLUSION a hernia surgeon may encounter unexpected intraoperative findings. It is important to be prepared to detect them and apply the appropriate treatment.
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Affiliation(s)
- K Ballas
- 2nd Department of Propaedeutic Surgery, Hippokratio General Hospital, Aristotle University Medical School, Thessaloniki, Greece
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