Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis

All patients diagnosed with EA between January 2004 and December 2006 at an urban surgical emergency room were retrospectively reviewed by two authors in order to share the authors' experience with this rare diagnosis. The operations were performed by two surgeons. Pathological examinations of specimens were performed by a single pathologist. A review of clinical presentation is additionally undertaken.Ten patients (3 females and 7 males, average age: 44.6 years, range: 27–76 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 80 %) and right (2 patients, 20%) lower quadrant. All patients were afebrile, and with the exception of one patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.2 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Treatment was laparoscopic excision (n = 8), excision via conventional laparotomy (n = 1) and conservative therapy (n = 1).In patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. Although infrequent up to date, with the increase of primary abdominal CT scans and ultrasound EA may well be diagnosed more frequently in the future.Epiploic appendages, also referred to as Appendices epiploicae, are between 50–100 fatty appendages originating in two rows (anterior and posterior) parallel to the external surface of the three longitudinal muscle bands of the large intestine known as taenia coli. First anatomically described in 1543 by Vesalius, they were not given any surgical significance until 1853 when Virchow suggested that their detachment might be a source of free intraperitoneal bodies [1,2].Epiploic appendages are between 0.5 and 5 cm long, each accompanied by one or two arterioles and a venule which is present in its va