Subscribe to RSS
DOI: 10.1055/a-1371-9359
Clinical Awareness and Acceptance of Sonographically Diagnosed Epiploic Appendagitis (EA): A Retrospective Analysis of EA in a Single Tertiary Academic Referral Center
Abstract
Purpose To describe the clinical awareness and acceptance of ultrasound-diagnosed acute epiploic appendagitis (EA) and their importance to avoid unnecessary therapeutic and imaging measures.
Patients and Methods The data were obtained of n=54 patients with acute, localized, peritonitic pain and EA diagnosed by B-mode ultrasound and contrast-enhanced ultrasound examination from November 2003 to September 2020. All examinations were performed by a German Society for Ultrasound in Medicine (DEGUM) Level III qualified examiner. Based on documentation by the treating physicians, the clinical awareness and acceptance of EA diagnosis was determined in all patients and compared between subgroups diagnosed before 2013 and from 2013 onwards. In 2013, a local educational training program regarding the diagnosis of and therapy for EA was initiated for physicians.
Results In all patients, EA was sonographically diagnosed by a DEGUM level III qualified examiner. At enrollment, EA was mentioned as a suspected clinical diagnosis in n=1/54 (1.9%) patient. Furthermore, in n=39/54 (72.2%) cases, the EA was documented and accepted by the treating physicians at the time of patient discharge as the final clinical diagnosis. The clinical acceptance was significantly higher from 2013 onwards compared with before 2013 (p<0.05). Moreover, in n=26/54 (48.1%) patients, unnecessary therapeutic measures were initiated, with no significant difference between pre-2013 and post-2013 numbers (p>0.05).
Conclusion In our retrospective study, we showed that awareness and acceptance of the disease EA are low. Low diagnostic acceptance of EA by the clinician leads to unnecessary therapeutic and imaging measures and is a general problem related to rare diseases in the healthcare system.
Key words
epiploic appendagitis - abdominal ultrasonography - CEUS - clinical awareness - clinical acceptancePublication History
Received: 24 November 2020
Accepted after revision: 24 January 2021
Article published online:
12 March 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Goethe JW, Von Müller F Goethes Unterhaltungen mit dem Kanzler Friedrich v. Müller. J. B. Gotta’sschen; 1870
- 2 Dharssi S, Wong-Rieger D, Harold M. et al. Review of 11 national policies for rare diseases in the context of key patient needs. Orphanet J Rare Dis 2017; 12: 63
- 3 Mechler K, Rausch J, Mountford WK. et al. Disease awareness or subtle product placement? Orphan diseases featured in the television series “House, M.D.” - a cross-sectional analysis. BMC Med Ethics 2020; 21: 20
- 4 Rao PM, Rhea JT, Wittenberg J. et al. Misdiagnosis of primary epiploic appendagitis. The American Journal of Surgery 1998; 81-85
- 5 de Brito P, Gomez MA, Besson M. et al. Fréquence et épidémiologiedescriptive de l’appendicite épiploïque primitive par l’exploration tomodensitométrique des douleurs abdominales de l’adulte. J Radiol 2008; 89: 235-243
- 6 Mollà E, Ripollés T, Martínez MJ. et al. Primary epiploic appendagitis: US and CT findings.. Eur Radiol 1998; 8: 435-438
- 7 Boardman J, Kaplan KJ, Hollcraft C. et al. Radiologic-pathologic conference of Keller Army Community Hospital at West Point, the United States Military Academy: Torsion of the epiploic appendage. AJR Am J Roentgenol 2003; 180: 748
- 8 Vinson DR. Epiploic appendagitis: A new diagnosis for the emergency physician. Two case reports and a review. Journal of Emergency Medicine 1999; 827-832
- 9 Hollerweger A, Macheiner P, Hübner E. et al. Spontane Nekrose einer Appendix epiploica: Sonographische Zeichen in 28 Fällen.. Ultraschall in Med 2002; 23: 239-244
- 10 Chen J-H, Wu C-C, Wu P-H. Epiploic appendagitis: An uncommon and easily misdiagnosed disease. J Dig Dis 2011; 12: 448-452
- 11 Görg C, Egbring J, Bert T. Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall in Med 2009; 30: 163-167
- 12 Choi YU, Choi PW, Park YH. et al. Clinical characteristics of primary epiploic appendagitis. J Korean Soc Coloproctol 2011; 27: 114-121
- 13 van Breda Vriesman AC, van Mol Otterloo AJ, de Puylaert JB. Epiploic appendagitis and omental infarction. Eur J Surg 2001; 167: 723-727
- 14 Sand M, Gelos M, Bechara FG. et al. Epiploic appendagitis--clinical characteristics of an uncommon surgical diagnosis. BMC Surg 2007; 7: 11
- 15 Giannis D, Matenoglou E, Sidiropoulou MS. et al. Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker. Ann Transl Med 2019; 7: 814
- 16 Tamandl D, Uray T. Akutes Abdomen: Was will der Kliniker vom Radiologen wissen?.. Radiologe 2019; 59: 95-105
- 17 Singh AK, Gervais DA, Hahn PF. et al. CT appearance of acute appendagitis. AJR Am J Roentgenol 2004; 183: 1303-1307
- 18 Dietrich CF, Lembcke B, Jenssen C. et al. Intestinal ultrasound in rare gastrointestinal diseases, update, part 1. Ultraschall in Med 2014; 35: 400-421
- 19 Dietrich CF, Lembcke B, Jenssen C. et al. Intestinal ultrasound in rare gastrointestinal diseases, update, Part 2. Ultraschall in Med 2015; 36: 428-456
- 20 Dong Y, Braden B, Klinger C. et al. Ultrasound findings in extragenital endometriosis. J Ultrason 2018; 18: 247-254
- 21 Dietrich CF, Hollerweger A, Dirks K. et al. EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features. Med Ultrason 2019; 21: 299-315
- 22 Dirks K, Calabrese E, Dietrich CF. et al. EFSUMB-Positionspapier: Empfehlungen für den gastrointestinalen Ultraschall (GIUS) bei akuter Appendizitis und Divertikulitis. Ultraschall in Med 2019; 40: 163-175
- 23 Hollerweger A, Maconi G, Ripolles T. et al. Gastrointestinaler Ultraschall (GIUS) bei intestinalen Notfällen – Ein EFSUMB-Positionspapier. Ultraschall in Med 2020;
- 24 Maconi G, Nylund K, Ripolles T. et al. EFSUMB-Empfehlungen und klinische Leitlinien für den gastrointestinalen Ultraschall (GIUS) chronisch entzündlichen Darmerkrankungen (CED). Ultraschall in Med 2018; 39: 304-317
- 25 Nylund K, Maconi G, Hollerweger A. et al. EFSUMB-Empfehlungen und Leitlinien des Gastrointestinalen Ultraschalls - Teil 1: Untersuchungstechniken und Normalbefund (Langversion). Ultraschall in Med 2017; 38: e1-e15
- 26 Nuernberg D, Saftoiu A, Barreiros AP. et al. EFSUMB recommendations for gastrointestinal ultrasound part 3: Endorectal, endoanal and perineal ultrasound. Ultrasound Int Open 2019; 5: E34-E51
- 27 Sidhu PS, Cantisani V, Dietrich CF. et al. Die EFSUMB-Leitlinien und Empfehlungen für den klinischen Einsatz des kontrastverstärkten Ultraschalls (CEUS) bei nicht-hepatischen Anwendungen: Update 2017 (Langversion). Ultraschall in Med 2018; 39: e2-e44
- 28 Hasbahceci M, Erol C, Seker M. Epiploic appendagitis: Is there need for surgery to confirm diagnosis in spite of clinical and radiological findings?. World J Surg 2012; 36: 441-446
- 29 Heese F, Görg C.. Diagnostische Wertigkeit einer internistischen Referenzsonographie (DEGUM-Stufe 3). Ultraschall in Med 2006; 27: 220-224
- 30 Amann-Vesti B, Bönhof JA, Görg C. Sonografie kompetent. Von der Indikation zur Interpretation. Stuttgart, New York: Georg Thieme Verlag; 2016