RESUMO
RESUMEN La apendagitis epiploica primaria es una rara causa de dolor abdominal que puede simular cualquier otro cuadro de abdomen agudo. Esto hace de su diagnóstico un verdadero desafío. Se presenta el caso de un paciente masculino de 22 años de edad, sin antecedentes de importancia que ingresó a la sala de emergencias con un cuadro de dolor abdominal de 36 horas de evolución. En la exploración física presentó dolor a la palpación en el flanco derecho. Se le realizó una tomografía axial de abdomen contrastada en la cual se observó una imagen redondeada con un halo hiperdenso con borramiento de planos grasos y cambios inflamatorios a su alrededor sin relación a otro órgano abdominal. Con estos hallazgos hicimos el diagnóstico de una apendagitis epiploica primaria. El paciente fue ingresado a la sala de internamiento para manejo del dolor y con mejoría clínica es egresado a las 48 horas asintomático. Si bien la apendagitis epiploica primaria es una causa infrecuente de dolor abdominal, consideramos que su conocimiento es relevante para evitar errores diagnósticos y terapéuticos que incrementan de forma innecesaria la morbilidad como el uso inadecuado de antibióticos y de recursos hospitalarios(AU)
ABSTRACT Primary epiploic appendagitis is a rare cause of abdominal pain that may mimic any other acute abdomen condition. This makes its diagnosis a real challenge for physicians. Here is a 22 years-old male patient, with no significant history of diseases, who were admitted to the emergency room because he had suffered abdominal pain for 36 hours. The physical exam revealed pain on palpating the right flank. He underwent a contrasted computed tomography of abdomen which showed a rounded image with hyperdense halo, fat plane effacement and inflammatory changes around, which was unrelated to another abdominal organ. These findings allowed diagnosing primary epiploic appendagitis. The patient was hospitalized for pain management and was discharged 48 hours later with clinical improvement and no symptoms. Primary epiploic appendagitis is infrequent cause of abdominal pain, however, we consider that it is important to know it so as to avoid diagnostic and therapeutic mistakes that might unnecessarily increase morbidity and the inadequate use of antibiotics and of hospital resources(AU)
Assuntos
Humanos , Masculino , Adulto , Literatura de Revisão como Assunto , Colo/diagnóstico por imagem , Abdome Agudo/diagnóstico por imagemRESUMO
Resumen La apendagitis aguda es una causa de dolor abdominal subdiagnosticada, ya que puede simular un cuadro de diverticulitis o apendicitis. Se debe a una torsión o trombosis del pedículo vascular de un apéndice epiploico que resulta en isquemia e infarto. El diagnóstico suele ser un hallazgo radiológico; sin embargo, tiene un curso autolimitado con resolución espontánea de 5 a 7 días.
Abstract Acute appendagitis is a cause of undiagnosed abdominal pain, as it may mimic diverticulitis or appendicitis. Torsion or thrombosis of the vascular pedicle of an epiploic appendage resulting in ischemia and infarction is due. The diagnosis is usually a radiological finding; however it has a self-limited course with spontaneous resolution of 5 to 7 days.
RESUMO
Resumen Antecedentes Los apéndices epiploicos son formaciones grasas, pediculadas, recubiertas de serosa, que se encuentran en la superficie externa del colon, hacia la cavidad peritoneal; su inflamación, torsión o infarto también se conoce como apendicitis epiploica o apendagitis. Caso clínico Presentamos el caso de un masculino de 35 años de edad quien acudió al Servicio de Urgencias del Hospital General Naval de Alta Especialidad por presentar dolor a nivel de la fosa iliaca derecha de inicio súbito, progresivo, el cual se protocolizó con estudios de laboratorio y gabinete, integrando el diagnóstico de probable apendicitis aguda; se realizaron hojas de solicitud quirúrgica y consentimiento informado para llevar a cabo apendicectomía abierta. Hallazgos: apéndice cecal de 5 × 1 centímetro de diámetro, de características macroscópicas normales e infarto de apéndice epiploico de colon ascendente a nivel de la válvula ileocecal. Conclusión Este caso se presenta para destacar las características clínicas de la apendagitis o apendicitis epiploica, que pueden ayudar a los médicos a sospechar esta patología benigna y llegar al diagnóstico correcto, evitando someter a un riesgo quirúrgico innecesario.
Abstract Background Epiploic appendices are pediculated, serosa-coated fat formations that are found on the outer surface of the colon, into the peritoneal cavity; their inflammation, torsion or infarction is also known as epiploic appendicitis or appendagitis. Clinical case We present the case of a 35-year-old man who went to the Emergency Service of the High Specialty Naval General Hospital because of sudden onset, progressive right iliac fossa pain, which was approached with laboratory and cabinet studies, integrating the diagnosis of probable acute appendicitis; surgical application sheets and informed consent were filled to perform open appendectomy, incidentally finding a cecal appendix 5 cm × 1 cm in diameter, with normal macroscopic characteristics, and infarction of ascending colon epiploic appendix at the ileocecal valve. Conclusion This case is presented to highlight the clinical characteristics of appendagitis or epiploic appendicitis, which can help clinicians suspect this benign pathology and reach the correct diagnosis, avoiding unnecessary surgical risk.
RESUMO
La apendagitis epiploica primaria es una enfermedad relativamente infrecuente dentro de los diagnósticos diferenciales del abdomen agudo. Describimos las características clínicas y evolución de una serie de 73 casos de apendagitis epiploica primaria. Se realizó una búsqueda de imágenes ecográficas y tomográficas con diagnóstico de apendagitis en el sistema de información hospitalario electrónico del Hospital Alemán entre abril del 2007 y julio del 2013 y posteriormente se revisaron sus historias clínicas. Se incluyeron 73 casos; la edad promedio fue de 45 años (± 16), 54 (74%) eran varones. El motivo de consulta fue dolor abdominal: en fosa ilíaca izquierda en 65 (el 89% de los casos); en fosa ilíaca derecha en seis (8%) y en otras localizaciones en dos (3%). Se les realizó ecografía abdominal a 44 (60%), tomografía computarizada a 21 (29%), y ambos estudios a 8 (11%). En el 49% de los casos se solicitó interconsulta con el servicio de cirugía. Recibieron tratamiento con antibióticos 15 (21%) pacientes, de los cuales el 73% fue indicado por un médico clínico. Recibieron tratamiento ambulatorio con antiinflamatorios no esteroides 67 (92%); dos requirieron cirugía laparoscópica, dos internación y dos opiáceos. La apendagitis epiploica es infrecuente dentro de los diagnósticos diferenciales de abdomen agudo, pero es una entidad que no debe ser desconocida por los médicos para prevenir intervenciones innecesarias y el uso excesivo de antibióticos.
Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colite/diagnóstico , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Colite/complicações , Colite/terapia , Diagnóstico Diferencial , Laparoscopia , Doenças Raras , Estudos RetrospectivosRESUMO
BACKGROUND: Epiploic appendagitis is an atypical cause of abdominal pain whose knowledge could avoid diagnostic or treatment errors. Diagnosis has been performed with abdominal ultrasound or tomography with the only treatment being nonsteroidal anti-inflammatory drugs. OBJECTIVE: To analyze patients diagnosed in our hospital. METHODS: We performed a 4-year retrospective and descriptive study (March 2009-March 2013) of patients diagnosed with epiploic appendagitis in our hospital. RESULTS: Seventeen patients were included, 14 females and three males with a median age of 57 years. Symptom delay was 72 h. Abdominal pains were located in the left lower quadrant in 64.7% and right lower quadrant in 35.3% of patients. Blood test demonstrated leukocytes 6,300 (5,000-9,500), neutrophils 61.6% (57-65.8), and C reactive protein 1.5 (0.85-2.92). Diagnosis was confirmed with abdominal ultrasound or tomography in 88.2% and intraoperatively in 11.8%. CONCLUSIONS: Epiploic appendagitis was more frequent in women. Abdominal pain was located in the lower quadrant, more predominant in left than right. Blood tests were normal except for increased levels of C-reactive protein. Diagnosis was made mostly preoperatively due to imaging tests, avoiding unnecessary surgical intervention.
ANTECEDENTES: la apendagitis epiploica es una causa poco frecuente de dolor abdominal cuyo conocimiento podría evitar errores diagnósticos y terapéuticos. El diagnóstico suele establecerse mediante ecografía o tomografía abdominal; el tratamiento es sintomático, con antiinflamatorios. OBJETIVO: analizar los casos diagnosticados en nuestro centro. MATERIAL Y MÉTODOS: estudio retrospectivo y descriptivo de pacientes con diagnóstico de apendagitis epiploica durante 4 años (marzo 2009 a marzo 2013). RESULTADOS: se incluyeron 17 pacientes, 14 mujeres y 3 hombres, con una mediana de edad de 57 años. El periodo de latencia de los síntomas fue 72 horas. En 64.7% de los pacientes el dolor abdominal se localizó en el cuadrante inferior izquierdo y en 35.3% en el derecho. Laboratorio: leucocitos 6,300 (5,000-9,500), neutrófilos 61.6% (57- 65.8), proteína C reactiva 1.5 (0.85-2.92). El diagnóstico se confirmó mediante ecografía o tomografía abdominal en 88.2%, e intraoperatorio en 11.8%. CONCLUSIONES: la apendagitis epiploica fue más frecuente en mujeres. La clínica fue dolor abdominal en los cuadrantes inferiores, más frecuente en el lado izquierdo, con RESULTADOS de laboratorio normales, excepto la elevación de la proteína C reactiva. En la mayoría de los casos el diagnóstico se estableció preoperatoriomente, gracias al uso de pruebas radiológicas que evitó las intervenciones quirúrgicas innecesarias.
Assuntos
Dor Abdominal/etiologia , Colo/patologia , Doenças do Colo/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Proteína C-Reativa/análise , Criança , Colo/diagnóstico por imagem , Colo/cirurgia , Doenças do Colo/sangue , Doenças do Colo/complicações , Doenças do Colo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Infarto/diagnóstico , Masculino , Pessoa de Meia-Idade , Omento/irrigação sanguínea , Paniculite Peritoneal/diagnóstico , Estudos Retrospectivos , Espanha/epidemiologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto JovemRESUMO
Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.
Assuntos
Colite/diagnóstico , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Adulto , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Colite/complicações , Colite/terapia , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Doenças Raras , Estudos RetrospectivosRESUMO
Apendagite epiplóica (AE) é uma doença inflamatória abdominal incomum, de bom prognóstico, que vem sendo mais freqüentemente diagnosticada em virtude dos avanços nos métodos de imagem. O achado clínico mais freqüente é dor em quadrante inferior esquerdo. O diagnóstico é obtido por meio da tomografia computadorizada. A recuperação do quadro é completa sob tratamento conservador.
Appendagitis is an uncommon inflammatory abdominal disease, with good prognosis; nowadays it is being diagnosed more frequently because of advances in imaging methods. Clinical finding most often described was abdominal pain over left lower quadrant. Diagnosis is obtained through computed tomography. Recovery is uneventful under conservative treatment.