Evaluation of the Contribution of Computed Tomography Findings and Neutrophil/Lymphocyte and Neutrophil/Platelet Ratios in the Diagnosis of Acute Epiploic Appendagitis

Year 2024, Volume: 11 Issue: 2, 82 - 87, 31.08.2024

Esra Soyer Güldoğan , Serra Özbal , Yeliz Aktürk , Baki Hekimoğlu

https://doi.org/10.47572/muskutd.1416941

Abstract

Acute epiploic appendicitis (AEA) is a rare disease characterized by infection or ischemia of fat-filled sacs around the colon. It is difficult to diagnose and can be confused with other acute abdominal pain requiring surgery. Computed tomography (CT) is the gold standard technique for acute epiploic appendicitis. Our study aims to evaluate the CT findings of acute epiploic appendicitis and the diagnostic value of neutrophil-lymphocyte ratios (NLR) and neutrophil-platelet ratios (NPR). We included one hundred twenty patients, 40 of whom were diagnosed with acute epiploic appendicitis, and 80 had similar complaints of abdominal pain and needed urgent surgery for treatment. First of all, power analysis was performed to determine the number of patients in the control group. Control group patients were determined by a lottery program. Pathologies detected in the control group were acute appendicitis, peptic ulcer perforation, colon perforation, mesenteric ischemia, ureteral stone, ovarian torsion, ovarian cyst rupture, and ectopic pregnancy rupture. The mean age in the AEA group was 41.6 years, and the group was predominantly male (70%). The most common complaint of the AEA group was abdominal pain (80.1%). NLR and NPR were significantly lower in the AEA group compared to the acute abdominal pain requiring surgery group (p<0.001). The cut-off values for NLR and NPR were 5.80 and 6.96, respectively. These findings suggest that neutrophil/lymphocyte ratio and neutrophil/platelet ratio may help diagnose AEA and distinguish it from various causes of abdominal pain that need urgent surgery, potentially preventing unnecessary surgical intervention.

Keywords

Acute Epiploic Appendicitis, Acute Abdominal Pain, Neutrophil-Lymphocyte Ratio, Neutrophil-Platelet Ratio

Akut Epiploik Apandajit Tanısında Bilgisayarlı Tomografi Bulguları ile Nötrofil/Lenfosit ve Nötrofil/Platelet Oranlarının Katkısının Değerlendirilmesi

Abstract

Akut epiploik apandisit (AEA) kolon çevresindeki yağla dolu keselerin enfeksiyonu veya iskemisi ile karakterize nadir bir hastalıktır. Teşhis edilmesi zordur ve ameliyat gerektiren diğer akut karın ağrısı ile karıştırılabilir. Bilgisayarlı tomografi (BT), akut epiploik apandisit tanısında altın standart tekniktir. Çalışmamız, karın ağrısı ile başvuran hastalarda AEA BT bulgularını ve tam kan sayımından elde edilen nötrofil-lenfosit ve nötrofil-trombosit oranlarının tanısal değerini değerlendirmeyi amaçlamaktadır. AEA tanısı konulan 40 hasta ve benzer karın ağrısı şikayeti olan ve tedavi için acil ameliyat gerektiren 80 hasta olmak üzere toplam 120 hastayı çalışmaya dahil ettik. Öncelikle kontrol grubundaki hasta sayısını belirlemek için güç analizi yapıldı. Kontrol grubu hastaları, akut cerrahi girişim gerektiren karın ağrısı olan hastalar arasından kura programı ile belirlendi. Kontrol grubunda akut apandisit, peptik ülser perforasyonu, kolon perforasyonu, mezenter iskemisi, üreter taşı, over torsiyonu, over kisti rüptürü ve ektopik gebelik rüptürü tespit edilen patolojiler idi. AEA grubundaki ortalama yaş 41.6 idi ve grubun çoğunluğu erkekti (%70) ve bu grupta en sık görülen şikayet karın ağrısı (%80.1) idi. Nötrofil/lenfosit ve nötrofil/platelet oranları, AEA grubunda, ameliyat gerektiren akut karın ağrısı grubuna göre anlamlı derecede düşüktü (p<0.001). Nötrofil/lenfosit oranı ve nötrofil/platelet oranı için kesim değerleri sırasıyla 5.80 ve 6.96 idi. Bu bulgular, nötrofil/lenfosit oranı ve nötrofil/platelet oranının akut epiploik apandisit tanısı koymaya ve onu acil cerrahi gerektiren çeşitli karın ağrısı nedenlerinden ayırmaya yardımcı olabileceğini ve potansiyel olarak gereksiz cerrahi müdahaleyi önleyebileceğini göstermektedir.

Keywords

Akut Epiploik Apandisit, Akut Karın Ağrısı, Nötrofil-Lenfosit Oranı, Nötrofil-Trombosit Oranı

Ethical Statement

The Ethics Committee of of clinical research of Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey approved the present study (36/06-27.03.2017).

Supporting Institution

None.

Thanks

None.

References

• 1. Schnedl WJ, Krause R, Tafeit E, et al. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 2011;8:45-9.
• 2. Gelrud A, Cárdenas A, Chopra S. 2022. Epiploic appendagitis. UpToDate. Post TW (ed): UpToDate, Waltham.
• 3. Almeida A, Melão L, Viamonte B, et al. Epiploic appendagitis: an entity frequently unknown to clinicians--diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol. 2009;193(5):1243-51
• 4. Charifi Y, Lamrani Y, Chbani L, et al. Acute abdomen in adult revealing unusual complicated epiploic appendagitis: a case report. Int J Surg Case Rep. 2020;75:112-6.
• 5. Yavuz K, Atasoy C, Akyarr S, et al. Primer epiploik apendagitis: Bilgisayarlı tomografi bulguları. Akad Gastro Derg. 2002;1(1):60-2.
• 6. Koplay M, Özbek S, Sivri M, et al. Primer epiploik apandisit: Klinik ve radyolojik görüntüleme bulguları. Dicle Tıp Derg. 2013;40(2):264-8.
• 7. Singh A, Gervais D, Hahn P, et al. CT appearance of acute appendagitis. AJR Am J Roentgenol. 2004;183(5):1303-7.
• 8. Rioux M, Langis P. Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 1994;191(2):523-6.
• 9. Molla E, Ripolles T, Martinez MJ, et al. Primary epiploic appendagitis: US and CT findings. Eur Radiol. 1998;8(3):435-8.
• 10. Giambelluca D, Cannella R, Caruana G, et al. (2019). CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain. Insights imaging. 2019;10(1):1-9.
• 11. López-Escobar A, Madurga R, Castellano JM, et al. Risk score for predicting in-hospital mortality in COVID-19 (RIM Score). Diagnostics (Basel). 2021;11(4):596.
• 12. Lisman T. Platelet-neutrophil interactions as drivers of inflammatory and thrombotic disease. Cell Tissue Res. 2018;371(3):567–76.
• 13. Gurel A, Dogukan A, Celiker H, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratios in peritoneal dialysis-related peritonitis. Turk Nephrol Dial Transplant J. 2015;24(2):158-61.
• 14. Sand M, Gelos M, Bechara FG, et al. Epiploic appendagitis—clinical characteristics of an uncommon surgical diagnosis. BMC Surg. 2007;7(1):11.
• 15. Kumar SVC, Mani KK, Alwakkaa H, et al. Epiploic appendagitis: an often misdiagnosed cause of acute abdomen. Case Rep Gastroenterol. 2020;13(3),364-8.
• 16. Shetty SD, Wattamwar A, Pai S, et al. Computed tomography imaging spectrum of primary epiploic appendagitis: experience from a tertiary care teaching hospital in India. Indian J Radiol Imaging. 2018;28(3):311-6.
• 17. Baba DF, Suciu H, Avram C, et al. Elevated levels of neutrophil-to monocyte ratio are associated with the initiation of paroxysmal documented atrial fibrillation in the first two months after heart transplantation: a uni-institutional retrospective study. J Cardiovasc Dev Dis. 2023;10(2):81.
• 18. Al-Bahrani AZ, Hassanain M, AlHashmi H, et al. Neutrophil-to-lymphocyte ratio as a predictor of severe acute pancreatitis. HPB (Oxford). 2017;19(7):591-6.
• 19. Kahramanca Ş, Özgehan G, Şeker D, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20(1):19-22.
• 20. Yang AP, Liu JP, Tao WQ, et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
• 21. Zhang J, Zhang HY, Li J, et al. The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(40),68837.
• 22. Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol. 2014;19:12-58.
• 23. Feng JF, Huang Y, Zhao Q, et al. Clinical significance of preoperative neutrophil lymphocyte ratio versus platelet lymphocyte ratio in patients with small cell carcinoma of the esophagus. Sci World J. 2013;2013:504365.
• 24. Wosnitzer M, Polland A, Hai Q, et al. Role of preoperative platelet level in clinical and pathological outcomes after surgery for renal cortical malignancies. Bju Int. 2011;108:73–9.
• 25. Gunaldi M, Goksu S, Erdem D, et al. Prognostic impact of platelet/lymphocyte and neutrophil/lymphocyte ratios in patients with gastric cancer: a multicenter study. Int J Clin Exp Med. 2015;8(4):5937-42.