title: Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis.
abstract: OBJECTIVE
  To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis.
  
  
  METHODS
  We retrospectively reviewed the clinical records and radiologic images of the patients who presented with left-sided acute abdominal pain and had computer tomography (CT) performed at the time of presentation showing radiological signs of left primary epiploic appendagitis (PEA) or left acute colonic diverticulitis (ACD) between January 2001 and December 2011. A total of 53 consecutive patients were enrolled and evaluated. We also compared the clinical characteristics, laboratory findings, treatments, and clinical results of left PEA with those of left ACD.
  
  
  RESULTS
  Twenty-eight patients and twenty-five patients were diagnosed with symptomatic left PEA and ACD, respectively. The patients with left PEA had focal abdominal tenderness on the left lower quadrant (82.1%). On CT examination, most (89.3%) of the patients with left PEA were found to have an oval fatty mass with a hyperattenuated ring sign. In cases of left ACD, the patients presented with a more diffuse abdominal tenderness throughout the left side (52.0% vs 14.3%; P = 0.003). The patients with left ACD had fever and rebound tenderness more often than those with left PEA (40.0% vs 7.1%, P = 0.004; 52.0% vs 14.3%, P = 0.003, respectively). Laboratory abnormalities such as leukocytosis were also more frequently observed in left ACD (52.0% vs 15.4%, P = 0.006).
  
  
  CONCLUSIONS
  If patients have left-sided localized abdominal pain without associated symptoms or laboratory abnormalities, clinicians should suspect the diagnosis of PEA and consider a CT scan.
authors.affiliation: Jeong Ah Hwang, Sun Moon Kim, Hyun Jung Song, Yu Mi Lee, Kyung Min Moon, Chang Gi Moon, Hoon Sup Koo, Kyung Ho Song, Yong Seok Kim, Tae Hee Lee, Kyu Chan Huh, Young Woo Choi, Young Woo Kang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 302-718, South Korea.
authors.forename: Jeong Ah
authors.initials: JA
authors.lastname: Hwang
authors.forename: Sun Moon
authors.initials: SM
authors.lastname: Kim
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Song
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Lee
authors.forename: Kyung Min
authors.initials: KM
authors.lastname: Moon
authors.forename: Chang Gi
authors.initials: CG
authors.lastname: Moon
authors.forename: Hoon Sup
authors.initials: HS
authors.lastname: Koo
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Yong Seok
authors.initials: YS
authors.lastname: Kim
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.forename: Kyu Chan
authors.initials: KC
authors.lastname: Huh
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Choi
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Kang
authors.forename: Woo Suk
authors.initials: WS
authors.lastname: Chung
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D004239:Diverticulitis, Colonic / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acute abdomen; Appendix epiploica; Colonic diverticulitis; Differential diagnosis; Multidetector computed tomography