title: Epiploic appendagitis: is there need for surgery to confirm diagnosis in spite of clinical and radiological findings?
abstract: BACKGROUND
  The present retrospective study was conducted to review the authors' experience and describe clinical and radiologic features of epiploic appendagitis (EA), which is an uncommon, self-limiting clinical entity mimicking acute appendicitis and diverticulitis. Awareness of the features of EA would allow a correct diagnosis and avoid unnecessary surgical interventions.
  
  
  METHODS
  Patients diagnosed as EA in one regional medical center between June 2006 and June 2010 were included. Clinical, laboratory, and imaging features of EA were studied, with particular attention to its unique radiologic appearances.
  
  
  RESULTS
  Twenty patients (13 men and 7 women; average age 43.2 years) diagnosed with EA were included in the study. Localized abdominal pain without nausea, vomiting, and fever were the major presenting symptoms for all patients. Laboratory blood tests were normal, except in one patient with leukocytosis and two patients with increased serum C-reactive protein (CRP) levels. A noncompressible hyperechoic ovoid mass with hypoechoic border and without central blood flow on Doppler ultrasound (US) was detected in five of six patients. In all patients, the computed tomography (CT) scans revealed an ovoid fatty mass with hyperattenuating rim and disproportionate adjacent fat stranding. Central dot sign, concomitant old infarct, and lobulation were present in 75%, 20%, and 10% of the patients, respectively. All of the patients were treated conservatively. No recurrences occurred during the follow-up period (average: 24.8 months) in 18 (90%) of the patients.
  
  
  CONCLUSIONS
  In patients with localized abdominal pain without other symptoms, diagnosis of EA should be considered. Recognizing the US and CT features of EA may allow an accurate diagnosis and avoid unnecessary surgery.
authors.affiliation: Department of General Surgery, Umraniye Education and Research Hospital, Hirka-i Serif M Kececi Cesmesi S Doktorlar S B Bl 6/7, Fatih, 34291, Istanbul, Turkey. hasbahceci@yahoo.com
authors.forename: Mustafa
authors.initials: M
authors.lastname: Hasbahceci
authors.forename: Cengiz
authors.initials: C
authors.lastname: Erol
authors.forename: Mehmet
authors.initials: M
authors.lastname: Seker
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001064:Appendicitis / Q000175:diagnosis; D003092:Colitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004238:Diverticulitis / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015434:Panniculitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents