title: Clinical characteristics of primary epiploic appendagitis.
abstract: OBJECTIVE
  Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis.
  
  
  METHODS
  We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications.
  
  
  RESULTS
  In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001).
  
  
  CONCLUSIONS
  In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.
authors.affiliation: Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors.forename: Young Un
authors.initials: YU
authors.lastname: Choi
authors.forename: Pyong Wha
authors.initials: PW
authors.lastname: Choi
authors.forename: Yong Hwan
authors.initials: YH
authors.lastname: Park
authors.forename: Jae Il
authors.initials: JI
authors.lastname: Kim
authors.forename: Tae Gil
authors.initials: TG
authors.lastname: Heo
authors.forename: Je Hoon
authors.initials: JH
authors.lastname: Park
authors.forename: Myung Soo
authors.initials: MS
authors.lastname: Lee
authors.forename: Chul Nam
authors.initials: CN
authors.lastname: Kim
authors.forename: Surk Hyo
authors.initials: SH
authors.lastname: Chang
authors.forename: Jeong Wook
authors.initials: JW
authors.lastname: Seo