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Epiploic appendagitis in a 27-year-old man.

Uehara R, Isomoto H, Yamaguchi N, Ohnita K, Fujita F, Ichikawa T, Takeshima F, Yamaguchi T, Uetani M, Nakao K - Med. Sci. Monit. (2011)

Bottom Line: Physical examination showed focal abdominal tenderness with slight rebound tenderness.The patient was given high-dose antibiotics due to the secondary inflammation involving the parietal peritoneum.Epiploic appendagitis presents with an abrupt onset of focal abdominal pain and tenderness without significant guarding or rigidity; it is an uncommon and difficult diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.

ABSTRACT

Background: Epiploic appendagitis is an ischemic infarction of an epiploic appendage caused by torsion or spontaneous thrombosis of the central draining vein. Epiploic appendagitis is self-limited without surgery, and it is imperative for clinicians to be familiar with this entity.

Case report: A healthy 27-year-old man was admitted due to acute right lower quadrant abdominal pain. Physical examination showed focal abdominal tenderness with slight rebound tenderness. Laboratory tests showed leukocytosis and an increased serum C-reactive protein level. Computed tomography (CT) showed a fatty ovoid pericolonic mass measuring 12 mm in diameter, with a circumferential hyperdense ring that abutted on the ascending colon and was surrounded by ill-defined fat stranding with a hyperdense ring. These findings were diagnostic of primary epiploic appendagitis. The patient was given high-dose antibiotics due to the secondary inflammation involving the parietal peritoneum.

Conclusions: Epiploic appendagitis presents with an abrupt onset of focal abdominal pain and tenderness without significant guarding or rigidity; it is an uncommon and difficult diagnosis. With awareness of this condition, however, evaluation by CT can provide an accurate diagnosis of epiploic appendagitis, distinguishing it from conditions with clinically overlapping manifestations.

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Related in: MedlinePlus

Computed tomography (CT), coronal section, shows a fatty oval lesion measuring 12 mm in diameter with a circumferential hyperdense ring in the right lower abdomen.
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f1-medscimonit-17-10-cs113: Computed tomography (CT), coronal section, shows a fatty oval lesion measuring 12 mm in diameter with a circumferential hyperdense ring in the right lower abdomen.

Mentions: A healthy 27-year-old man was admitted to our hospital due to acute right lower quadrant abdominal pain. He denied nausea, vomiting, or diarrhea. On physical examination, the blood pressure was 111/64 mmHg, the heart rate was 75 beats per minute and regular, the respiratory rate was 16 breaths per minute, and the temperature was 37.9°C. Abdominal examination showed focal abdominal tenderness with slight rebound tenderness. Bowel sounds were normal, and no tumor was palpable. Laboratory tests showed a white blood cell count of 9000/mm3 (3900/mm3 to 8900/mm3) and a CRP of 8.7 mg/dL (<0.17 mg/dL). Otherwise, the laboratory data were within normal limits. The patient was treated with cefmetazole sodium (2 g/day) for 2 days, but the symptoms became worse. The antimicrobial dose was increased to 4 g/day for the subsequent 3 days. An abdominal series and ultrasound of the upper abdomen were performed and interpreted as normal. On the coronal section of computed tomography (CT), a fatty oval lesion measuring 12 mm in diameter with a circumferential hyperdense ring (arrow, Figure 1) was seen in the right lower abdomen. The transverse CT image showed that the ovoid, pericolonic mass abutted on the ascending colon and was surrounded by ill-defined fat stranding (arrow, Figure 2). Thickening of the parietal peritoneum was seen (arrow heads, Figure 3). There was neither free air nor ascites, and the appendix was normal. These findings were diagnostic of primary epiploic appendagitis. Antibiotics were discontinued. Oral loxoprofen sodium (60 mg) was prescribed twice before his symptoms and signs resolved with normalization of the laboratory results. The patient was doing well at the last outpatient follow-up visit.


Epiploic appendagitis in a 27-year-old man.

Uehara R, Isomoto H, Yamaguchi N, Ohnita K, Fujita F, Ichikawa T, Takeshima F, Yamaguchi T, Uetani M, Nakao K - Med. Sci. Monit. (2011)

Computed tomography (CT), coronal section, shows a fatty oval lesion measuring 12 mm in diameter with a circumferential hyperdense ring in the right lower abdomen.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539461&req=5

f1-medscimonit-17-10-cs113: Computed tomography (CT), coronal section, shows a fatty oval lesion measuring 12 mm in diameter with a circumferential hyperdense ring in the right lower abdomen.
Mentions: A healthy 27-year-old man was admitted to our hospital due to acute right lower quadrant abdominal pain. He denied nausea, vomiting, or diarrhea. On physical examination, the blood pressure was 111/64 mmHg, the heart rate was 75 beats per minute and regular, the respiratory rate was 16 breaths per minute, and the temperature was 37.9°C. Abdominal examination showed focal abdominal tenderness with slight rebound tenderness. Bowel sounds were normal, and no tumor was palpable. Laboratory tests showed a white blood cell count of 9000/mm3 (3900/mm3 to 8900/mm3) and a CRP of 8.7 mg/dL (<0.17 mg/dL). Otherwise, the laboratory data were within normal limits. The patient was treated with cefmetazole sodium (2 g/day) for 2 days, but the symptoms became worse. The antimicrobial dose was increased to 4 g/day for the subsequent 3 days. An abdominal series and ultrasound of the upper abdomen were performed and interpreted as normal. On the coronal section of computed tomography (CT), a fatty oval lesion measuring 12 mm in diameter with a circumferential hyperdense ring (arrow, Figure 1) was seen in the right lower abdomen. The transverse CT image showed that the ovoid, pericolonic mass abutted on the ascending colon and was surrounded by ill-defined fat stranding (arrow, Figure 2). Thickening of the parietal peritoneum was seen (arrow heads, Figure 3). There was neither free air nor ascites, and the appendix was normal. These findings were diagnostic of primary epiploic appendagitis. Antibiotics were discontinued. Oral loxoprofen sodium (60 mg) was prescribed twice before his symptoms and signs resolved with normalization of the laboratory results. The patient was doing well at the last outpatient follow-up visit.

Bottom Line: Physical examination showed focal abdominal tenderness with slight rebound tenderness.The patient was given high-dose antibiotics due to the secondary inflammation involving the parietal peritoneum.Epiploic appendagitis presents with an abrupt onset of focal abdominal pain and tenderness without significant guarding or rigidity; it is an uncommon and difficult diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.

ABSTRACT

Background: Epiploic appendagitis is an ischemic infarction of an epiploic appendage caused by torsion or spontaneous thrombosis of the central draining vein. Epiploic appendagitis is self-limited without surgery, and it is imperative for clinicians to be familiar with this entity.

Case report: A healthy 27-year-old man was admitted due to acute right lower quadrant abdominal pain. Physical examination showed focal abdominal tenderness with slight rebound tenderness. Laboratory tests showed leukocytosis and an increased serum C-reactive protein level. Computed tomography (CT) showed a fatty ovoid pericolonic mass measuring 12 mm in diameter, with a circumferential hyperdense ring that abutted on the ascending colon and was surrounded by ill-defined fat stranding with a hyperdense ring. These findings were diagnostic of primary epiploic appendagitis. The patient was given high-dose antibiotics due to the secondary inflammation involving the parietal peritoneum.

Conclusions: Epiploic appendagitis presents with an abrupt onset of focal abdominal pain and tenderness without significant guarding or rigidity; it is an uncommon and difficult diagnosis. With awareness of this condition, however, evaluation by CT can provide an accurate diagnosis of epiploic appendagitis, distinguishing it from conditions with clinically overlapping manifestations.

Show MeSH
Related in: MedlinePlus