Md. Saiful Islam1
1. Associate professor, Department of Radiology and Imaging, North East Medical College Sylhet.
Abstract
Primary epiploic appendagitis (PEA) is a rare and self-limiting cause of acute abdomen. It is important for clinician to be aware of an epiploic appendagitis to avoid delay in diagnosis, unnecessary hospital stay and surgical intervention. CT scan should be done in cases of acute abdomen (if not absolutely contraindicated) for confirmation of diagnosis, as in our case CT scan helped in confirmation of diagnosis of PEA and thus avoided unnecessary surgical intervention. Here we present a case of PEA in a 29 years-old, healthy male with a chief complaint of acute left iliac fossa pain. Laboratory investigation reports were more or less within normal limits; CT scan confirmed the diagnosis of PEA. The patient was managed successfully with an oral antibiotic and a non-steroidal anti-inflammatory drug. After careful correlation among clinical, radiological, and laboratory findings, diagnosis of PEA was confirmed. The patient was managed conservatively at home with the advice of plenty of fluid intake and bed rest. Furthermore, he was prescribed an oral and injectable antibiotic and a non-steroidal anti-inflammatory drug (ibuprofen) for seven days to prevent further complications like adhesions, bowel obstruction, intussusception, peritonitis, and local abscess formation. The patient recovered completely (the symptoms and signs resolved clinically) after 3 weeks. To conclude, it can be said, diagnosis of epiploic appendagitis should remain in differential diagnosis list of acute abdomen, although rare in occurrence and lacking in specific presenting features. Diagnosis of PEA has become easier with imaging techniques like CT scan and MRI:A prompt diagnosis of PEA avoid unnecessary surgical interventions.
Key Words: acute abdomen, computed tomography, exploratory laparotomy, primary epiploic appendagitis (PEA)