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Clinical Characteristics of Primary Epiploic Appendagitis

대한대장항문학회지 2011년 27권 3호 p.114 ~ 121
 ( Choi Young-Un ) - Inje University College of Medicine Department of Surgery

 ( Choi Pyong-Wha ) - Inje University College of Medicine Department of Surgery
 ( Park Yong-Hwan ) - Inje University College of Medicine Department of Surgery
 ( Kim Jae-Il ) - Inje University College of Medicine Department of Surgery
 ( Heo Tae-Gil ) - Inje University College of Medicine Department of Surgery
 ( Park Je-Hoon ) - Inje University College of Medicine Department of Surgery
 ( Lee Myung-Soo ) - Inje University College of Medicine Department of Surgery
 ( Kim Chul-Nam ) - Inje University College of Medicine Department of Surgery
 ( Chang Surk-Hyo ) - Inje University College of Medicine Department of Surgery
 ( Seo Jeong-Wook ) - Inje University College of Medicine Department of Radiology

Abstract


Purpose: Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis.

Methods: We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications.

Results: In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001).

Conclusion: In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.

키워드

Epiploic appendagitis; Diverticulitis; Acute abdomen
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