Apendagitis epiploica aguda como causa de dolor abdominal agudo

Résumé

BACKGROUND. Epiploic appendagitis (EA) is an uncommon condition that typically presents with acute abdominal pain in the lower half of the abdomen. The differential diagnosis of the cause of pain requires urgent consideration of multiple conditions. Computed tomography is usually required for diagnosis. MATERIAL AND METHODS. This is a retrospective case series of patients diagnosed with epiploic appendagitis. All were diagnosed in the emergency department after suspicion of acute abdomen. RESULTS. Seventeen patients were included in the series. The mean (SD) age at presentation was 56.53 (18.39) years. Symptoms were present for less than 24 hours in 5 patients (29.4%) and more than 48 hours in 9 (52.9%). Abdominal pain as the presenting symptom was in the left lower quadrant (6 patients), the right lower quadrant (8 patients); mesogastric in 1 patient, and epigastric in 2 patients. EA was diagnosed based on imaging in all cases. The location was the sigmoid colon in 5 cases (29.4%), the descending colon in 4 (23.5%), the ascending colon in 2 (11.7%), the cecum in 5 (29.4%), and the transverse colon in 1 (5.8%). Three patients (17.6%) were treated surgically. Outpatient treatment with an oral analgesic was prescribed for 8 patients (47.1%), and 5 patients (29.3%) were admitted to receive IV analgesia. Symptoms resolved without surgery after 1 week. Recurrence within 2 years has not been reported in any of the cases. CONCLUSIONS. EA is a self limited condition that normally resolves within 2 weeks with treatment of symptoms. Physicians should consider EA as a possible cause of abdominal pain given that a late or erroneous diagnosis can lead to prolonged hospitalization, unnecessary prescription of antibiotics, unnecessary surgery, and higher health care costs.