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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31820c5f59
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Epiploic Appendagitis

Goh, Vi Lier; Rudolph, Colin D

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Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI, USA.

Received 24 November, 2010

Revised 14 December, 2010

Accepted 20 December, 2010

Address correspondence and reprint requests to Vi Lier Goh, MD, Children's Hospital of Wisconsin, Pediatric Gastroenterology and Nutrition, 9000 W Wisconsin Ave, Milwaukee, WI 53226 (e-mail: vgoh@mcw.edu).

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 17-year-old healthy boy presented to the emergency department (ED) with acute, localized left upper quadrant constant abdominal pain, exacerbated by movements. He denied other symptoms. The physical examination was normal except rebound and point tenderness localized to the left upper quadrant of his abdomen. Laboratory studies, including inflammatory markers, were normal. His abdominal computed tomography (CT) findings were diagnostic of an epiploic appendagitis (Fig. 1).

Figure 1
Figure 1
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Epiploic appendagitis is a benign self-limiting condition caused by torsion of the small, fat-filled sacs or finger-like projections along the surface of the lower colon and rectum, the epiploic appendages. Pain described as sharp or stabbing is localized in the affected area; more often in the left lower than in the right lower quadrant (1). Sometimes there is nausea and vomiting. The physical examination can mimic an acute abdomen (2,3) and can be misdiagnosed as appendicitis, cholecystitis, or diverticulitis. A lack of elevation in inflammatory markers or fever is suggestive of a more benign process (4). Despite its rare occurrence in children, epiploic appendagitis should be considered when evaluating abdominal pain. Abdominal CT findings include findings of an oval lesion with attenuation similar to that of fat, surrounded by a hyperattenuated ring, located near but distinct from the colon, often with periappendageal fat stranding in the absence of other diagnostic abnormalities (5). Early identification by imaging studies may prevent unnecessary surgical procedures. A well-looking child with this diagnosis can be discharged home with anti-inflammatory, analgesic treatment (3) and careful follow-up.

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REFERENCES

1. Sand M, Gelos M, Bechara FG, et al. Epiploic appendagitis clinical characteristics of an uncommon surgical diagnosis. BMC Surg 2007; 7:11.

2. Carmichael DH, Organ CG Jr. Epiploic disorders. Conditions of the epiploic appendages. Arch Surg 1985; 120:1167–1172.

3. Legome EL, Belton AL, Murray RE, et al. Epiploic appendagitis: the emergency department presentation. J Emerg Med 2002; 22:9.

4. Rioux M, Langis P. Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology 1994; 191:523.

5. Singh AK, Gervais DA, Hahn PF, et al. Acute epiploic appendagitis and its mimics. Radiographics 2005; 25:1521–1534.

Copyright 2011 by ESPGHAN and NASPGHAN

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