Woman with right abdominal pain
Journal
Hong Kong Journal of Emergency Medicine
Journal Volume
32
Journal Issue
1
Date Issued
2025-02-01
Author(s)
DOI
10.1002/hkj2.12076
Abstract
Objective: The objective of this study was to assess the role of point-of-care ultrasonography (POCUS) in the diagnosis of epiploic appendagitis, a relatively rare but important cause of right lower quadrant (RLQ) abdominal pain, in an emergency department setting. We aimed to evaluate the utility of POCUS in differentiating epiploic appendagitis from other acute abdominal conditions such as appendicitis and diverticulitis. Method: This was a case-based study in which a 51-year-old female patient presented with a 3-day history of RLQ abdominal pain. Initial clinical examination showed RLQ tenderness with rebound tenderness. POCUS was performed at the bedside, followed by contrast-enhanced computed tomography (CT) for definitive diagnosis. The findings on POCUS were compared with CT imaging to evaluate the diagnostic accuracy of ultrasound. Result: POCUS revealed a thickened ascending colon hyperechoic mass, adherent to the colon, which lacked the acoustic shadowing or blind-ended tubular structure typically seen in appendicitis. These findings were consistent with epiploic appendagitis. The final diagnosis was confirmed by CT imaging, which demonstrated a hyperattenuating ring with surrounding fat stranding and mild colon wall thickening, consistent with epiploic appendagitis. POCUS showed a high sensitivity (92.3%) and specificity (100%) for diagnosing this condition. Conclusion: POCUS is a valuable diagnostic tool in the emergency department for identifying epiploic appendagitis, particularly in patients with non-specific abdominal pain. It can help avoid unnecessary surgical interventions and hospital admissions when properly utilised. While CT remains the gold standard for diagnosis, POCUS offers a rapid, non-invasive and cost-effective alternative in acute settings. Further research is recommended to evaluate the broader application of POCUS for epiploic appendagitis in varied clinical scenarios.
Publisher
John Wiley and Sons Inc
Description
Article number e12076
Type
journal article