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Epiploik apandisit, günlük protikte gözden kaçırılan acil bir durum

Yıl 2024, Cilt: 23 Sayı: 3, 114 - 118, 25.12.2024
https://doi.org/10.17941/agd.1601027

Öz

Amaç
Akut epiploik apandisit, akut karın ağrısının nadir görülen ve kolaylıkla yanlış teşhis edilebilen bir nedenidir. Epiploik uzantıların benign, kendi kendini sınırlayan inflamatuar veya iskemik hasarı ile veya komşu karın organlarını etkileyen diğer inflamatuar durumlara sekonder olabilir. Epiploik apandisit teşhisinin hasta yönetiminde net bir klinik önemi vardır. Akut karın ağrısı durumunda akut apandisit ve divertikülit gibi genellikle cerrahi müdahale gerektiren diğer durumların taklitçisi olan bu durumun tanısında görüntüleme önemli bir rol oynar. Çalışmamızın amacı akut karın ağrısıyla gelen yetişkin hastalarda epiploik apandisit tanı oranını ve en sık tanısal yanılgıya neden olan patolojileri belirlemektir.

Gereç ve Yöntemler
01.01.2022-31.12.2022 tarihleri arasında travma olmaksızın akut karın ağrısı nedeniyle acil servise başvuran ve tanı amacıyla abdomen bilgisayarlı tomografi (BT) tetkiki yapılan yetişkin hastalar retrospektif olarak incelendi. BT tetkiklerinde sık görülen akut abdomen nedenleri araştırılarak hastalar gruplandırıldı. The study was accepted by the decision number 2023/125 of the non-invasive clinical research ethics committee on 18.10.2023.
Bulgular
Bir yıllık sürede acil serviste akut karına tanısal yaklaşım amacıyla BT görüntüleme tetkiki yapılan 139’ u erkek olmak üzere toplam 256 hasta olduğu görüldü. Sık görülen akut karın nedenlerine göre BT bulguları gruplandırıldı. 256 hastanın 8’inde BT bulgularının epiploic apandisitle uyumlu olduğu görüldü. Bu 8 hastanın anamnez, fizik muayene ve laboratuvar bulguları retrospektif olarak incelendi.
Sonuç
Akut karın ağrısının tedavisinde gereksiz cerrahi girişimlerden kaçınmak için acil hekimleri ve radyologların sık rastlanmayan bu klinik durumu akılda tutması gerekmektedir.

Kaynakça

  • 1. Singh AK, Gervais DA, Hahn PF, et al. Acute epiploic appendagitis and its mimics. Radiographics. 2005;25(6):1521-34.
  • 2. Almeida AT, Melão L, Viamonte B, Cunha R, Pereira JM. Epiploic appendagitis: an entity frequently unknown to clinicians--diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol. 2009;193(5):1243-51.
  • 3. Pereira JM, Sirlin CB, Pinto PS, et al. Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics. 2004;24(3):703-15.
  • 4. Ghahremani GG, White EM, Hoff FL, et al. Appendices epiploicae of the colon: radiologic and pathologic features. Radiographics. 1992;12(1):59-77.
  • 5. Subr Subramaniam R. Acute appendagitis: emergency presentation and computed tomographic appearances. Emerg Med J. 2006;23(10):e53.
  • 6. de Brito P, Gomez MA, Besson M, Scotto B, Huten N, Alison D. Fréquence et épidémiologie descriptive de l'appendicite épiploïque primitive par l'exploration tomodensitométrique des douleurs abdominales de l'adulte [Frequency and epidemiology of primary epiploic appendagitis on CT in adults with abdominal pain]. J Radiol. 2008;89(2):235-43. French.
  • 7. Schnedl WJ, Krause R, Tafeit E, et al. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 2011;8(1):45-9.
  • 8. Choi YU, Choi PW, Park YH, et al. Clinical characteristics of primary epiploic appendagitis. J Korean Soc Coloproctol. 2011;27(3):114-21.
  • 9. Mollà E, Ripollés T, Martínez MJ, Morote V, Roselló-Sastre E. Primary epiploic appendagitis: US and CT findings. Eur Radiol. 1998;8(3):435-8.
  • 10. Nadida D, Amal A, Ines M, et al. Acute epiploic appendagitis: Radiologic and clinical features of 12 patients. Int J Surg Case Rep 2016;28:219-22.
  • 11. Son HJ, Lee SJ, Lee JH, et al. Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis. J Clin Gastroenterol 2002;34:435-8.
  • 12. Hasbahceci M, Erol C, Seker M. Epiploic appendagitis: is there need for surgery to confirm diagnosis in spite of clinical and radiological findings? World J Surg 2012;36:441-6.
  • 13. Gourgiotis S, Oikonomou C, Veloudis G, et al. The Diagnostic Dilemma of Primary Epiploic Appendagitis and How to Establish a Diagnosis. Oman Med J 2016;31:235-7.
  • 14. Jalaguier A, Zins M, Rodallec M, et al. Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis. Emerg Radiol. 2010;17(1):51-6.
  • 15. Osada H, Ohno H, Watanabe W, et al. Multidetector computed tomography diagnosis of primary and secondary epiploic appendagitis. Radiat Med. 2008;26(10):582-6.
  • 16. Chen JH, Wu CC, Wu PH. Epiploic appendagitis: an uncommon and easily misdiagnosed disease. J Dig Dis. 2011;12(6):448-52.
  • 17. Suresh Kumar VC, Mani KK, Alwakkaa H, Shina J. Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen. Case Rep Gastroenterol. 2019;13(3):364-8.
  • 18. Görg C, Egbring J, Bert T. Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall Med. 2009;30(2):163-7.
  • 19. Choi YU, Choi PW, Park YH, et al. Clinical characteristics of primary epiploic appendagitis. J Korean Soc Coloproctol. 2011;27(3):114-21.
  • 20. van Breda Vriesman AC, de Mol van Otterloo AJ, Puylaert JB. Epiploic appendagitis and omental infarction. Eur J Surg. 2001;167(10):723-7.
  • 21. Nugent JP, Ouellette HA, O'Leary DP, et al. Epiploic appendagitis: 7-year experience and relationship with visceral obesity. Abdom Radiol (NY). 2018;43(7):1552-7.
  • 22. Giannis D, Matenoglou E, Sidiropoulou MS, et al. Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker. Ann Transl Med. 2019;7(24):814.
  • 23. Legome EL, Sims C, Rao PM. Epiploic appendagitis: adding to the differential of acute abdominal pain. J Emerg Med. 1999;17(5):823-6.

Epiploic appendagitis, an overlooked emergency in the daily practice

Yıl 2024, Cilt: 23 Sayı: 3, 114 - 118, 25.12.2024
https://doi.org/10.17941/agd.1601027

Öz

Introduction
Acute epiploic appendagitis is an uncommon and easily misdiagnosed cause of acute abdominal pain. The diagnosis of epiploic appendagitis has clear clinical importance in patient management. In the case of acute abdominal pain, Radiology plays a critical role in the diagnosis of this condition, which often mimics other conditions that require surgical intervention. The aim of this article is to evaluate the frequency and presentation of acute epiploic appendicitis in our patient population and to remind them of this pathology.
Materials and Methods
Adult patients applied to the emergency department with acute abdominal pain and were evaluated with abdominal computed tomography (CT) between January 2022 and December 2022 were retrospectively analyzed. Patients were grouped according to the common causes of acute abdomen. The frequency and common presentation of epiploic appendagitis were researched.
Results
In the 1-year retrospective radiology database search, CT findings were consistent with epiploic appendicitis in 8 of 256 patients. The anamnesis, physical examination, and laboratory findings of these 8 patients were examined retrospectively.
Conclusion
Epiploic appendagitis is a rare but self-limiting cause of acute abdomen. In the management of acute abdominal pain, emergency physicians and radiologists should also remember this clinical situation in order to avoid unnecessary surgical interventions.

Kaynakça

  • 1. Singh AK, Gervais DA, Hahn PF, et al. Acute epiploic appendagitis and its mimics. Radiographics. 2005;25(6):1521-34.
  • 2. Almeida AT, Melão L, Viamonte B, Cunha R, Pereira JM. Epiploic appendagitis: an entity frequently unknown to clinicians--diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol. 2009;193(5):1243-51.
  • 3. Pereira JM, Sirlin CB, Pinto PS, et al. Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics. 2004;24(3):703-15.
  • 4. Ghahremani GG, White EM, Hoff FL, et al. Appendices epiploicae of the colon: radiologic and pathologic features. Radiographics. 1992;12(1):59-77.
  • 5. Subr Subramaniam R. Acute appendagitis: emergency presentation and computed tomographic appearances. Emerg Med J. 2006;23(10):e53.
  • 6. de Brito P, Gomez MA, Besson M, Scotto B, Huten N, Alison D. Fréquence et épidémiologie descriptive de l'appendicite épiploïque primitive par l'exploration tomodensitométrique des douleurs abdominales de l'adulte [Frequency and epidemiology of primary epiploic appendagitis on CT in adults with abdominal pain]. J Radiol. 2008;89(2):235-43. French.
  • 7. Schnedl WJ, Krause R, Tafeit E, et al. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 2011;8(1):45-9.
  • 8. Choi YU, Choi PW, Park YH, et al. Clinical characteristics of primary epiploic appendagitis. J Korean Soc Coloproctol. 2011;27(3):114-21.
  • 9. Mollà E, Ripollés T, Martínez MJ, Morote V, Roselló-Sastre E. Primary epiploic appendagitis: US and CT findings. Eur Radiol. 1998;8(3):435-8.
  • 10. Nadida D, Amal A, Ines M, et al. Acute epiploic appendagitis: Radiologic and clinical features of 12 patients. Int J Surg Case Rep 2016;28:219-22.
  • 11. Son HJ, Lee SJ, Lee JH, et al. Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis. J Clin Gastroenterol 2002;34:435-8.
  • 12. Hasbahceci M, Erol C, Seker M. Epiploic appendagitis: is there need for surgery to confirm diagnosis in spite of clinical and radiological findings? World J Surg 2012;36:441-6.
  • 13. Gourgiotis S, Oikonomou C, Veloudis G, et al. The Diagnostic Dilemma of Primary Epiploic Appendagitis and How to Establish a Diagnosis. Oman Med J 2016;31:235-7.
  • 14. Jalaguier A, Zins M, Rodallec M, et al. Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis. Emerg Radiol. 2010;17(1):51-6.
  • 15. Osada H, Ohno H, Watanabe W, et al. Multidetector computed tomography diagnosis of primary and secondary epiploic appendagitis. Radiat Med. 2008;26(10):582-6.
  • 16. Chen JH, Wu CC, Wu PH. Epiploic appendagitis: an uncommon and easily misdiagnosed disease. J Dig Dis. 2011;12(6):448-52.
  • 17. Suresh Kumar VC, Mani KK, Alwakkaa H, Shina J. Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen. Case Rep Gastroenterol. 2019;13(3):364-8.
  • 18. Görg C, Egbring J, Bert T. Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall Med. 2009;30(2):163-7.
  • 19. Choi YU, Choi PW, Park YH, et al. Clinical characteristics of primary epiploic appendagitis. J Korean Soc Coloproctol. 2011;27(3):114-21.
  • 20. van Breda Vriesman AC, de Mol van Otterloo AJ, Puylaert JB. Epiploic appendagitis and omental infarction. Eur J Surg. 2001;167(10):723-7.
  • 21. Nugent JP, Ouellette HA, O'Leary DP, et al. Epiploic appendagitis: 7-year experience and relationship with visceral obesity. Abdom Radiol (NY). 2018;43(7):1552-7.
  • 22. Giannis D, Matenoglou E, Sidiropoulou MS, et al. Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker. Ann Transl Med. 2019;7(24):814.
  • 23. Legome EL, Sims C, Rao PM. Epiploic appendagitis: adding to the differential of acute abdominal pain. J Emerg Med. 1999;17(5):823-6.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gastroenteroloji ve Hepatoloji
Bölüm Makaleler
Yazarlar

Feyza Sönmez Topcu 0000-0002-7450-2949

Ender Anılır 0000-0002-0024-1790

Yayımlanma Tarihi 25 Aralık 2024
Gönderilme Tarihi 5 Nisan 2024
Kabul Tarihi 16 Nisan 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 23 Sayı: 3

Kaynak Göster

APA Sönmez Topcu, F., & Anılır, E. (2024). Epiploic appendagitis, an overlooked emergency in the daily practice. Akademik Gastroenteroloji Dergisi, 23(3), 114-118. https://doi.org/10.17941/agd.1601027

test-5