PII S0736-4679(99)00089-X Clinical Communications EPIPLOIC APPENDAGITIS: ADDING TO THE DIFFERENTIAL OF ACUTE ABDOMINAL PAIN Eric L. Legome, MD,* Carrie Sims, MD, MS,† and Patrick M. Rao, MD‡ Departments of *Emergency Medicine, †Surgery, and ‡Radiology, Massachusetts General Hospital, Boston, Massachusetts Reprint Address: Eric Legome, MD, Department of Emergency Medicine, Massachusetts General Hospital, Clinics Building 115, Boston, MA 02139 e Abstract—We report a patient with epiploic appendagi- tis who presented with acute abdominal pain. Emergency Department and discharge courses are described. The pathophysiology, presentation, diagnosis, and treatment of this disorder are discussed. Knowledge of this uncommonly diagnosed entity and its usual benign course may allow the Emergency Physician to order the appropriate studies to help avoid unnecessary surgical treatment. © 1999 Elsevier Science Inc. e Keywords— epiploic; appendagitis; abdominal; torsion; acute INTRODUCTION The acute abdomen is a common presentation in the Emergency Department (ED). It is important to differ- entiate cases requiring surgical treatment from those that may be managed more conservatively. Epiploic ap- pendagitis, or inflammation of an appendix epiploica, is an often benign condition that may present with perito- neal findings. Awareness of this diagnosis is important, as it may help avoid a laparotomy. We present a case report of epiploic appendagitis and review the pertinent signs, symptoms, and characteristic radiologic findings, and offer a rational diagnostic and treatment strategy. CASE REPORT A 29-year-old male was referred to our ED by his pri- mary care physician because of 4 days of worsening dull, aching left lower quadrant abdominal pain. The pain began intermittently and became constant. Movement, deep breathing, and coughing exacerbated it. There were no relievers. There was no radiation of the pain. The patient denied fever or rigors. He denied dysuria but reported urinary frequency. Because of diuretic usage, however, this was usual for him. He denied hematuria or penile discharge. He also complained of one episode of emesis the day of presentation, along with mild anorexia over the day. The patient’s medical history was significant for an inferior myocardial infarction at age 23. He also had a history of chronic low back pain. His family history was significant for coronary artery disease in the early 30s. His medications included furosemide, lisinopril, aspirin, isorbide dinitrate, and digoxin. He had no drug allergies and no prior surgery. The presenting vital signs were: blood pressure of 110/62 mmHg, a pulse of 78 beats/min, a respiratory rate of approximately 18 breaths/min, and an oral tempera- ture of 36.3°C. The patient was a well-developed and well-nourished thin male who appeared nontoxic, al- though moderately uncomfortable with movement. The Clinical Communications (Adults) is coordinated by Ron M. Walls, MD, of Brigham and Women’s Hospital and Harvard University Medical School, Boston, Massachusetts RECEIVED: 8 June 1998; FINAL SUBMISSION RECEIVED: 19 October 1998; ACCEPTED: 11 November 1998 The Journal of Emergency Medicine, Vol. 17, No. 5, pp. 823– 826, 1999 Copyright © 1999 Elsevier Science Inc. Printed in the USA. All rights reserved 0736-4679/99 $–see front matter 823