The role of laboratory parameters in discriminating between acute diverticulitis and acute epiploic appendagitis: a comprehensive analysis

Aims: Acute diverticulitis (AD) and primary epiploic appendagitis (EA) are two distinct pathological entities that often present with similar clinical features, complicating the process of differential diagnosis. While AD is an inflammatory condition of the diverticula that may progress to significant complications, EA represents a self-limiting inflammatory process originating from ischemic infarction of an epiploic appendage. Accurate differentiation between these two conditions is crucial, as management strategies differ significantly: AD may require hospitalization and antibiotic therapy, while EA is typically managed conservatively. Laboratory parameters have been increasingly investigated to assist in the early and accurate diagnosis of these conditions. This study aims to evaluate the diagnostic value of routine laboratory parameters and to develop a novel scoring system to help clinicians distinguish between AD and EA. Methods: A retrospective analysis was conducted on 184 patients diagnosed with either EA or AD at Hitit University Medical Faculty Erol Olçok Training and Research Hospital between January 1, 2013, and January 1, 2022. Demographic data, laboratory values, including white blood cell count (WBC), neutrophil (NE), lymphocyte (LY), hemoglobin (Hb), platelet (Plt), mean platelet volume (MPV), albumin (Alb), creatine kinase (CK), and C-reactive protein (CRP), lesion localization, comorbidities, hospitalization status, length of stay, complications, interventions, recurrence, and colonoscopy findings were recorded. Comparative analyses between the EA and AD groups were performed. Multivariate analysis identified significant predictors for developing the Ramcho Index (RI) and the Ramcho Score (RS), which integrate laboratory and clinical parameters to create an objective, numeric index and a 0–9 point scale. Results: Among the 184 patients, 109 were diagnosed with AD and 75 with EA. CRP, neutrophil-lymphocyte ratio (NLR), and CRP-albumin ratio (CAR) were significantly elevated in AD (all p<0.001). The mean RI was significantly higher in AD (58.9±104.7) compared to EA (16.3±81.8; p<0.001). Similarly, RS was significantly elevated in AD (5.2±1.9) compared to EA (2.7±2.0; p<0.001). An RS threshold of ≥5 predicted AD with 64.2% sensitivity and 81.3% specificity (OR 7.821, 3.881-15,757, p<0.001). When all diagnostic markers were compared, it was found that the RS was superior to other tests with 71.1% accuracy. A patient with an RS of 5 or above was 6.82 times more likely to belong to the AD group than a patient with an RS score below 5. Conclusion: The RS offers a reliable and practical adjunct to physical examination, clinical history, laboratory inflammatory markers, and imaging findings in differentiating AD from EA. It can be safely utilized in clinical practice to support diagnostic decision-making.