UNUSUAL CAUSES OF THE ACUTE ABDOMINAL PAIN: IMAGING AND CLINICAL FINDINGS

Yıl 2019, Cilt: 10 Sayı: 2, 53 - 57, 01.04.2019

Ercan Ayaz Ahmet Aktan Abdullah Alimoğlu İdris Ozdas

https://doi.org/10.33706/jemcr.551138

Öz

Introduction: Acute abdominal pain is a common complaint of patients in
the emergency department that needs to be evaluated rapidly
and comprehensively. With a wide range of etiologies, acute abdominal
pain is still a major diagnostic challenge in the emergency department.
Radiological imaging is the corner stone of the diagnostic work up along with
clinical and laboratory findings.

Case
report: In
this case report, we present our 4 cases of acute abdominal pain caused by rare
disorders (epiploic appendagitis, omental infarction, mesenteric panniculitis
and cecal diverticulitis) that were initially diagnosed mistakenly based on
clinical findings. These good mimickers masqueraded themselves as common
etiologies of acute abdomen such as acute appendicitis, diverticulitis and
cholecystitis.

Conclusion:  After radiographs, ultrasonography
(US) and computed tomography (CT) are the most common imaging modalities that
are performed in emergency departments for acute abdominal pain. Both US and CT
are highly accurate imaging modalities that commonly reveal the correct
diagnosis. However, rare disorders may not be recognized in the acute setting.
We present our cases with US and CT images to remind radiologists and emergency
physicians of these mimickers of acute abdominal pain in
order to prevent unnecessary surgeries.

Anahtar Kelimeler

acute abdominal pain, emergency radiology, cecal diverticulitis, epiploic appendagitis, mesenteric panniculitis

Kaynakça

• 1. Stoker J, van Randen A, Lameris W, Boermeester A. Imaging Patients with Acute Abdominal Pain. Radiology 2009; 253: 31–46.
• 2. Gans SL, Pols MA, Stoker J, Boermeester MA. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain. Dig Surg 2015; 32: 23–31.
• 3. Cartwright SL, Knudson MP. Diagnostic Imaging of Acute Abdominal Pain in Adults. Am Fam Physician. 2015; 91: 452-9.
• 4. ACR appropriateness criteria, 2006. American College of Radiology Web site. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonGastrointestinalImaging/AcuteAbdominalPainandFeverorSuspectedAbdominalAbscessDoc1.aspx. Accessed October 15, 2008.
• 5. Kellow ZS, MacInnes M, Kurzencwyg D, Rawal S, Jaffer R, Kovacina B, et al. The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology 2008; 248: 887–93.
• 6. Allemann F, Cassina P, Rothlin M, Largiader F. Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study. Eur J Surg 1999; 165: 966–70.
• 7. Mun S, Ernst RD, Chen K, Oto A, Shah S, Mileski WJ. Rapid CT diagnosis of acute appendicitis with IV contrast material. Emerg Radiol 2006; 12: 99–102.
• 8. Lameris W, van Randen A, van Es HW, van Heesewijk JPM, van Ramshorst B, Bouma WH, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 2009; 338: b2431.
• 9. Burcu B, Ekinci O, Inan I, Ozyalvac FT, Eren TT, Alimoglu O. An unusual cause of acute abdomen–epiploic appendicitis: report of two cases. North Clin Istanbul 2015; 2: 171–4.
• 10. Golash V, Willson PD. Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients. Surg Endosc. 2005; 19: 882–5.
• 11. Sand M, Gelos M, Bechara FG, Sand D, Wiese TH, Steinstraesser L, et al. Epiploic appendagitis-clinical characteristics of an uncommon surgical diagnosis. BMC Surg 2007; 7: 11.
• 12. Nyberg L , Björk J, Björkdahl P, Ekberg O, Sjöberg K, Vigren L. Sclerosing mesenteritis and mesenteric panniculitis – clinical experience and radiological features. BMC Gastroenterology 2017; 17: 75.
• 13. Kyziridis DS, Parpoudi SN, Antoniou ND, Konstantaras DC, Moysidis MG, Christoforidis EC, et al. Cecal Diverticulitis is a Challenging Diagnosis: A Report of 3 Cases. Am J Case Rep, 2015; 16: 206-10.