Epiploik Apendiks Enflamasyonu: Primer Epiploik Apandajit

Yıl 2019, Cilt: 21 Sayı: 1, 102 - 108, 30.04.2019

Sevilay Vural Figen Coşkun

https://doi.org/10.24938/kutfd.529130

Cited By: 1

Öz

Epiploik apendiks kolonun çoğunu kaplayan omental uzantılardır. Patolojik değişikliklerin çoğu spontan torsiyon veya venöz tromboz sonrası oluşan enflamasyon ile ilişkilidir ve primer epiploik apandajit olarak adlandırılır. Nispeten nadir görülen bu intra-abdominal patoloji için herhangi bir patognomonik semptom, bulgu veya laboratuvar testi yoktur. Sağ veya sol alt kadranda akut başlangıçlı lokalize karın ağrısı olan non-toksik görünümdeki hasta tipik prezentasyondur. İntra-abdominal patolojilerin ayırıcı tanısında primer epiploik apandajit farkındalığı ile ultrason ve tomografi gibi görüntüleme çalışmaları doğru tanı koymada anahtar role sahiptir. Konservatif tedavi çoğu durumda yeterli olduğundan doğru ve zamanında tanı ile uygun hasta yönetimi sağlanıp gereksiz hastane yatışları ve girişimler önlenebilir.

Anahtar Kelimeler

Apendiks epiploica, apandajit, yağ nekrozu, akut batın, ayırıcı tanı

THE INFLAMMATION OF EPIPLOIC APPENDIX: PRIMARY EPIPLOIC APPENDAGITIS

Öz

Epiploic appendices are extensions of omentum which covers most of the colon. Most of the pathologic changes are related with spontaneous torsion or venous thrombosis culminating with inflammation and is referred as primary epiploic appendagitis (PEA). There is no pathognomonic symptom, finding or laboratory test for this relatively rare intra-abdominal inflammation. A non-toxic patient with acute onset localized abdominal pain in the right or left lower quadrant is the typical presentation. Imaging studies such as ultrasound and tomography with the awareness of PEA in differential diagnoses of intra-abdominal pathologies are the key to correct diagnosis. Since the conservative treatment is sufficient in most of cases, accurate and timely diagnosis can ensure the appropriate patient management and can prevent unnecessary hospitalizations and interventions.

Anahtar Kelimeler

Appendix epiploica, appendagitis, fat necrosis, acute abdomen, differential diagnosis

Kaynakça

• 1. Vesalius A. De humanis corporis fabrica libri septem. Basileae: (ex officina Ioannis Oporini), (Anno salutis reparatae 1543). Digitized 1543 Edition. Doi:10.3931/e-rara-20094.
• 2. 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. Doi:10.1186/1471-2482-7-11. PubMed PMID:17603914.
• 3. Saad J, Mustafa HA, Elsani AM, Alharbi F, Alghamdi S. Primary epiploicappendagitis: reconciling CT and clinical challenges. Indian J Gastroenterol. 2014;33:420–426. Doi:10.1007/s12664-014-0466-y. PubMed PMID:24934824.
• 4. Schnedl WJ, Krause R, Tafeit E, Tillich M, Lipp RW, Wallner-Liebmann SJ. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 2011;8(1):45-49. Doi:10.1038/nrgastro.2010.189. PubMed PMID:21102533.
• 5. Vinson DR. Epiploic appendagitis: a new diagnosis for the emergency physician. Two case reports and a review. J Emerg Med. 1999;17:827-32. Doi:10.1016/S0736-4679(99)00090-6. PubMed PMID:10499697.
• 6. Jalaguier A, Zins M, Rodallec M, Nakache JP, Boulay-Coletta I, Jullès MC. 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. Doi:10.1007/s10140-009-0822-x. PubMed PMID:19517148.
• 7. Fieber SS, Forman J. Appendices epiploicae: clinical and pathological considerations: report of three cases and statistical analysis on one hundred five cases. AMA Arch Surg. 1953;66:329-38. PubMed PMID:13030059.
• 8. Choi YU, Choi PW, Park YH, Kim JI, Heo TG, Park JH et al. Clinical characteristics of primary epiploic appendagitis. J Korean Soc Coloproctol. 2011;27:114-21. Doi:10.3393/jksc.2011.27.3.114. PubMed PMID:21829765.
• 9. Son HJ, Lee SJ, Lee JH, Kim JS, Kim YH, Rhee PL et al. Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis. J Clin Gastroenterol. 2002;34:435-8. Doi:10.1097/00004836-200204000-00010. PubMed PMID:11907356.
• 10. Legome EL, Belton AL, Murray RE, Rao PM, Novelline RA. Epiploic appendagitis: the emergency department presentation. J Emerg Med. 2002;22:9-13. Doi: 10.1016/S0736-4679(01)00430-9. PubMed PMID:11809550.
• 11. Rao PM, Novelline RA. Case 6: primary epiploic appendagitis. Radiology. 1999;210:145-8. Doi: 10.1148/radiology.210.1.r99ja33145. PubMed PMID:9885599.
• 12. Molla E, Ripolles T, Martinez MJ, Morote V, Rosello-Sastre E. Primary epiploic appendagitis: US and CT findings. Eur Radiol. 1998;8:435–8. Doi:10.1007/s003300050408. PubMed PMID:9510579.
• 13. Golash V, Willson PD. Early laparoscopy as a routine procedure in the management of acute abdominal pain: A review of 1320 patients. Surg Endosc. 2005;19:882-5. Doi:10.1007/s00464-004-8866-1. PubMed PMID:15920682.
• 14. Redmond P, Sawaya DE, Miller KH, Nowicki MJ. Epiploic Appendagitis: A Rare Cause of Acute Abdominal Pain in Children. Report of a Case and Review of the Pediatric Literature. Pediatr Emerg Care. 2015;31(10):717-9. Doi:10.1097/PEC.0000000000000565. PubMed PMID:26427946.
• 15. Ghahremani GG, White EM, Hoff FL, Gore RM, Miller JW, Christ ML. Appendices epiploicae of the colon: radiologic and pathologic features. Radiographics. 1992;12:59-77. Doi:10.1148/radiographics.12.1.1734482. PubMed PMID:1734482.
• 16. Cakiroglu B, Sinanoglu O, Abci I, Tas T, Dogan AN, Aksoy SH et al. An unusual cause of hematuria; primary epiploic appendagitis. Int J Surg Case Rep. 2014;5(12):902-5. Doi:10.1016/j.ijscr.2014.09.012. PubMed PMID:25460432.
• 17. Rioux M, Langis P. Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 1994;191:523-6. Doi:10.1148/radiology.191.2.8153333. PubMed PMID:8153333.
• 18. Hollerweger A, Macheiner P, Hubner E, Rettenbacher T Gritzmann. Epiploic appendagitis: sonographic findings in 28 cases. Ultraschall Med. 2002;4:239-44. Doi:10.1055/s-2002-34057. PubMed PMID:12226761.
• 19. Danse EM, Van Beers BE, Baudrez V, Pauls C, Baudrez Y, Kartheuser A et al. Epiploic appendagitis: Color Doppler sonographic findings. Eur Radiol. 2001;11:183-6. Doi:10.1007/s003300000672. PubMed PMID:11218011.
• 20. Barbier C, Denny P, Pradoura JM, Bui P, Rieger A, Bazin C et al. Radiologic aspects of infarction of the appendix epiploica. J Radiol. 1998;79:1479-85. PubMed PMID:9921450.
• 21. Singh AK, Gervais DA, Hahn PF, Rhea J, Mueller PR. CT appearance of acute appendagitis. AJR Am J Roentgenol. 2004;183:1303–7. Doi:10.2214/ajr.183.5.1831303. PubMed PMID:15505294.
• 22. Giambelluca D, Dimarco M, Vaccaro Notte MR, Lo Re G, Midiri M. The "central dot sign" in acute epiploic appendagitis. Abdom Radiol. 2018. (Epub 2018 September 25, ahead of print). Doi:10.1007/s00261-018-1785-8. PubMed PMID:30255443.
• 23. Subramaniam R. Acute appendagitis: emergency presentation and computed tomographic appearances. Emerg Med J. 2006;23:e53. Doi:10.1136/emj.2005.033704. PubMed PMID:16988291.
• 24. Han Q, Nair RT, DiSantis DJ. The hyperattenuating ring sign of acute epiploic appendagitis. Abdom Radiol. 2016;41:1431-2. Doi:10.1007/s00261-016-0641-y. PubMed PMID:27315096.
• 25. Romaniuk CS, Simpkins KC. Case report: pericolic abscess secondary to torsion of an appendix epiploica. Clin Radiol. 1993;47:216-7. PubMed PMID:8472491.
• 26. Kulacoglu H, Tumer H, Aktimur R, Kusdemir A. Internal herniation with fatal outcome: herniation through an unusual apertura between epiploic appendices and greater omentum. Acta Chir Belg. 2006;106:109-11. Doi:10.1080/00015458.2006.11679849. PubMed PMID:16612930.