Torsion of the primary epiploic appendagitis: a case series and review of the literature

BackgroundDifferential diagnosis and appropriate treatment of epiploic appendagitis (EA) is a dilemma for general surgeons because of nonspecific signs and symptoms.MethodsTwelve patients (3 women and 9 men, average age 40 years, range 18–82 years) who were diagnosed as having EA upon presenting to the emergency department or at the time of discharge between April 2002 and September 2008 were included.ResultsThe major presenting symptom was abdominal pain. Physical examination revealed well-localized tenderness in all cases (n = 12); in addition, rebound tenderness and distention were also observed. Laboratory blood tests were normal except for 4 patients who had leukocytosis. Seven cases were diagnosed by an abdominal computed tomography scan. Five patients required surgical intervention, whereas the remaining did not.ConclusionsSurgeons should be aware of this self-limiting disease that mimics many other intra-abdominal acute conditions. An abdominal computed tomography scan has a significant role in accurate diagnosis of EA before surgery to avoid unnecessary surgical interventions.