Appendagitis epiploica: een onderbelichte zelflimiterende acute buikaandoening

To describe the clinical findings in patients with epiploic appendagitis and to evaluate its natural course.

Design

Retrospective.

Method

A review of the medical records was carried out for all patients who were diagnosed with epiploic appendagitis using ultrasonography and computed tomography (CT), during the period June 1988-October 2001, at the Haaglanden Medical Centre (Westeinde site), The Hague, the Netherlands.

Results

The study group consisted of 49 patients, 38 men and 11 women, with a median age of 41 years. The main symptom was focal abdominal pain, with a median diagnostic delay in the patients of 2 days, located in the left lower quadrant (n = 34), right lower quadrant (n = 8), right upper quadrant (n = 6) or left upper quadrant (n = 1) of the abdomen. No other complaints were present with the exception of nausea and vomiting in two patients. Leucocytosis was found in 21 of patients, the erythrocyte sedimentation rate was elevated in 26 of the patients, and signs of peritoneal irritation were found in 53 of the patients. Epiploic appendagitis was correctly included in the clinical differential diagnosis of 2 patients. All of the patients made a complete and uncomplicated recovery under conservative treatment; the majority were symptom-free within 9 days.

Conclusion

Due to the increased use of diagnostic imaging in patients with acute abdominal symptoms, epiploic appendagitis is much more frequently diagnosed than before. Presenting symptoms of epiploic appendagitis are non-specific, leading to misdiagnosis in most cases. Epiploic appendagitis has a benign natural course and if patients are correctly diagnosed using ultrasonography and CT, unnecessary surgery and medical treatment may be avoided.