Epiploik Apendajıt ve Omental Enfarkt
Özet
Epiploik apendajit ve omental enfarkt, kolonik epiploik appendikslerin veya omental yağ dokusunun segmental iskemik nekrozu ve buna eşlik eden steril inflamasyon ile karakterize, çoğu olguda kendini sınırlayan iki benign tablodur. Klinik prezantasyonun apandisit ve akut divertikülit ile benzerliği, acil serviste gereksiz antibiyotik kullanımı, hastaneye yatış ve cerrahi girişimlere yol açabilir. Kontrastlı abdominal bilgisayarlı tomografi tipik morfolojik bulgularla tanıyı yüksek doğrulukla destekler ve güvenli konservatif yönetimi mümkün kılar. Bu bölümde epiploik apendajit ve omental enfarktın anatomi-patofizyoloji temeli, klinik ve görüntüleme özellikleri, ayırıcı tanı ve acil serviste pratik yönetim ilkeleri kanıta dayalı olarak özetlenmiştir.
Epiploic appendagitis and omental infarction are benign, often self-limited conditions caused by segmental ischemic necrosis of colonic epiploic appendages or omental fat with sterile inflammation. They frequently mimic appendicitis and acute diverticulitis, which may lead to unnecessary antibiotics, hospital admission, or surgery in the emergency department. Contrast-enhanced abdominal computed tomography (CT) provides characteristic morphologic findings that support an accurate diagnosis and enable safe conservative management. This chapter reviews the anatomy–pathophysiology, clinical and imaging features, differential diagnosis, and a pragmatic emergency department approach for both entities based on current evidence.
Referanslar
van Breda Vriesman AC, de Mol van Otterloo AJ, Puylaert JBCM. Epiploic appendagitis and omental infarction. European Journal of Surgery. 2001;167(10):723-727. doi:10.1080/11024150152707680.
Singh AK, Gervais DA, Hahn PF, et al. Acute epiploic appendagitis and its mimics. Radiographics. 2005;25(6):1521-1534. doi:10.1148/rg.256055030.
Giannis D, Matenoglou E, Sidiropoulou MS, et al. Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker. Annals of Translational Medicine. 2019;7(24):814. doi:10.21037/atm.2019.12.74.
Legome EL, Belton AL, Murray RE, et al. Epiploic appendagitis: the emergency department presentation. Journal of Emergency Medicine. 2002;22(1):9-13. doi:10.1016/S0736-4679(01)00430-9.
Jalaguier A, Zins M, Rodallec M, et al. Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis. Emergency Radiology. 2010;17(1):51-56. doi:10.1007/s10140-009-0822-x.
Hwang JA, Kim SM, Song HJ, et al. Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis. World Journal of Gastroenterology. 2013;19(40):6842-6848. doi:10.3748/wjg.v19.i40.6842.
Rioux M, Langis P. Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 1994;191(2):523-526. doi:10.1148/radiology.191.2.8153333.
Mollà E, Ripollés T, Martínez MJ, et al. Primary epiploic appendagitis: US and CT findings. European Radiology. 1998;8(3):435-438.
Rao PM, Wittenberg J, Lawrason JN. Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology. 1997;204(3):713-717. doi:10.1148/radiology.204.3.9280248.
Tan R, Parys S, Watanabe Y. Diagnosis and management of epiploic appendagitis: a single-institution 10-year experience. Polish Przegląd Chirurgiczny. 2021;93(6):20-24. doi:10.5604/01.3001.0014.8912.
Sartelli M, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World Journal of Emergency Surgery. 2020;15(1):32. doi:10.1186/s13017-020-00313-4.
Di Saverio S, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 2020;15(1):27. doi:10.1186/s13017-020-00306-3.
Hasbahceci M, Erol C, Seker M. Epiploic appendagitis: is there need for surgery to confirm diagnosis in spite of clinical and radiological features?. World Journal of Surgery. 2012;36(2):441-446. doi:10.1007/s00268-011-1347-8.
van Breda Vriesman AC, Lohle PNM, Coerkamp EG, Puylaert JBCM. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. European Radiology. 1999;9(9):1886-1892. doi:10.1007/s003300050942.
Pemmada V, Shetty A, Koteshwar P, et al. Primary omental infarction – a benign cause of acute abdomen. Pleura Peritoneum. 2024;9(2):63-68. doi:10.1515/pp-2023-0037.
Idrissi MB, Akammar A, et al. Diagnosing and treating epiploic appendagitis: a review of two cases. Journal of Surgical Case Reports. 2023;2023(3):rjad156. doi:10.1093/jscr/rjad156.
Puylaert JBCM. Right-sided segmental infarction of the omentum: clinical, US, and CT findings. Radiology. 1992;185(1):169-172. doi:10.1148/radiology.185.1.1523302.
Abadir JS, Cohen AJ, Wilson SE. Omental infarction: report of 3 cases and review of the literature. American Surgeon. 2004;70(11):1032-1035.
Diab J, Badiani S, Berney CR. Diagnosis and management of adult omental infarction: a 10-year case series. World Journal of Surgery. 2021;45(6):1734-1741. doi:10.1007/s00268-021-06043-1.
Medina-Gallardo NA, Curbelo-Peña Y, Stickar T, et al. Omental infarction: surgical or conservative treatment? A case reports and case series systematic review. Annals of Medicine and Surgery. 2020;56:186-193. doi:10.1016/j.amsu.2020.06.031.
Rimon A, Daneman A, Gerstle JT, et al. Omental infarction in children. Journal of Pediatrics. 2009;155(3):427-431.e1. doi:10.1016/j.jpeds.2009.03.039.
McClure MJ, Khalili K, Sarrazin J, et al. Radiological features of epiploic appendagitis and segmental omental infarction. Clinical Radiology. 2001;56(10):819-827. doi:10.1053/crad.2001.0848.
Nubi A, McBride W, Stringel G. Primary omental infarct: conservative vs operative management in the era of ultrasound, computerized tomography, and laparoscopy. Journal of Pediatric Surgery. 2009;44(5):953-956. doi:10.1016/j.jpedsurg.2009.01.032.
Varjavandi V, Lessin M, Kooros K, et al. Omental infarction: risk factors in children. Journal of Pediatric Surgery. 2003;38(2):233-235. doi:10.1053/jpsu.2003.50051.
Almeida RR, Singh AK, Mansouri M, et al. Impact of Radiology Report Wording on Care of Patients With Acute Epiploic Appendagitis. AJR American Journal of Roentgenology. 2019;212:1265-1270. doi:10.2214/AJR.18.20747.
Referanslar
van Breda Vriesman AC, de Mol van Otterloo AJ, Puylaert JBCM. Epiploic appendagitis and omental infarction. European Journal of Surgery. 2001;167(10):723-727. doi:10.1080/11024150152707680.
Singh AK, Gervais DA, Hahn PF, et al. Acute epiploic appendagitis and its mimics. Radiographics. 2005;25(6):1521-1534. doi:10.1148/rg.256055030.
Giannis D, Matenoglou E, Sidiropoulou MS, et al. Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker. Annals of Translational Medicine. 2019;7(24):814. doi:10.21037/atm.2019.12.74.
Legome EL, Belton AL, Murray RE, et al. Epiploic appendagitis: the emergency department presentation. Journal of Emergency Medicine. 2002;22(1):9-13. doi:10.1016/S0736-4679(01)00430-9.
Jalaguier A, Zins M, Rodallec M, et al. Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis. Emergency Radiology. 2010;17(1):51-56. doi:10.1007/s10140-009-0822-x.
Hwang JA, Kim SM, Song HJ, et al. Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis. World Journal of Gastroenterology. 2013;19(40):6842-6848. doi:10.3748/wjg.v19.i40.6842.
Rioux M, Langis P. Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 1994;191(2):523-526. doi:10.1148/radiology.191.2.8153333.
Mollà E, Ripollés T, Martínez MJ, et al. Primary epiploic appendagitis: US and CT findings. European Radiology. 1998;8(3):435-438.
Rao PM, Wittenberg J, Lawrason JN. Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology. 1997;204(3):713-717. doi:10.1148/radiology.204.3.9280248.
Tan R, Parys S, Watanabe Y. Diagnosis and management of epiploic appendagitis: a single-institution 10-year experience. Polish Przegląd Chirurgiczny. 2021;93(6):20-24. doi:10.5604/01.3001.0014.8912.
Sartelli M, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World Journal of Emergency Surgery. 2020;15(1):32. doi:10.1186/s13017-020-00313-4.
Di Saverio S, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 2020;15(1):27. doi:10.1186/s13017-020-00306-3.
Hasbahceci M, Erol C, Seker M. Epiploic appendagitis: is there need for surgery to confirm diagnosis in spite of clinical and radiological features?. World Journal of Surgery. 2012;36(2):441-446. doi:10.1007/s00268-011-1347-8.
van Breda Vriesman AC, Lohle PNM, Coerkamp EG, Puylaert JBCM. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. European Radiology. 1999;9(9):1886-1892. doi:10.1007/s003300050942.
Pemmada V, Shetty A, Koteshwar P, et al. Primary omental infarction – a benign cause of acute abdomen. Pleura Peritoneum. 2024;9(2):63-68. doi:10.1515/pp-2023-0037.
Idrissi MB, Akammar A, et al. Diagnosing and treating epiploic appendagitis: a review of two cases. Journal of Surgical Case Reports. 2023;2023(3):rjad156. doi:10.1093/jscr/rjad156.
Puylaert JBCM. Right-sided segmental infarction of the omentum: clinical, US, and CT findings. Radiology. 1992;185(1):169-172. doi:10.1148/radiology.185.1.1523302.
Abadir JS, Cohen AJ, Wilson SE. Omental infarction: report of 3 cases and review of the literature. American Surgeon. 2004;70(11):1032-1035.
Diab J, Badiani S, Berney CR. Diagnosis and management of adult omental infarction: a 10-year case series. World Journal of Surgery. 2021;45(6):1734-1741. doi:10.1007/s00268-021-06043-1.
Medina-Gallardo NA, Curbelo-Peña Y, Stickar T, et al. Omental infarction: surgical or conservative treatment? A case reports and case series systematic review. Annals of Medicine and Surgery. 2020;56:186-193. doi:10.1016/j.amsu.2020.06.031.
Rimon A, Daneman A, Gerstle JT, et al. Omental infarction in children. Journal of Pediatrics. 2009;155(3):427-431.e1. doi:10.1016/j.jpeds.2009.03.039.
McClure MJ, Khalili K, Sarrazin J, et al. Radiological features of epiploic appendagitis and segmental omental infarction. Clinical Radiology. 2001;56(10):819-827. doi:10.1053/crad.2001.0848.
Nubi A, McBride W, Stringel G. Primary omental infarct: conservative vs operative management in the era of ultrasound, computerized tomography, and laparoscopy. Journal of Pediatric Surgery. 2009;44(5):953-956. doi:10.1016/j.jpedsurg.2009.01.032.
Varjavandi V, Lessin M, Kooros K, et al. Omental infarction: risk factors in children. Journal of Pediatric Surgery. 2003;38(2):233-235. doi:10.1053/jpsu.2003.50051.
Almeida RR, Singh AK, Mansouri M, et al. Impact of Radiology Report Wording on Care of Patients With Acute Epiploic Appendagitis. AJR American Journal of Roentgenology. 2019;212:1265-1270. doi:10.2214/AJR.18.20747.
