İkbal KAYGUSUZ, HİLAL USLU YUVACI, İlknur İnegöl GÜMÜŞ, Önder SÜRGİT, Aslı KÖKTENER

Epiploic appendagitis after laparoscopic total hysterectomy suggested an ureter injury

Akut alt kadran a ğ rı s ı n ı n nadir bir nedeni olan epiploik, apandisit (EA), benign kendini s ı n ı rlayan, klinikopatolojik ve radyolojik bir durumdur. Biz laparoskopik histerektomi sonras ı 7. günde üreter yaralanmas ı n ı taklit eden akut karı n a ğ rı s ı olan 49 ya şı ndaki bir kad ı n olgu sunduk. Abdominal muayenede sol alt kadranda hassasiyet saptand ı . Anormal laboratuvar test sonuçlar ı lökositoz ve artm ı ş CRP düzeyleri idi. Abdominal ultrasonografide anlaml ı anormalliklere rastlanmad ı . Bilgisayarl ı Tomografi (BT)de EA için patognomonik bulgular olan inflamatuvar de ğ iş iklikler ile çevrili ya ğ yo ğ unluklu lezyonlar görüldü. EA, appendiksin torsiyonu ya da appendisyal drene edici venin torsiyonu sonucu veya yak ı ndaki inflamatuar süreçlere ba ğ l ı olarak olu ş ur. Çe ş itli akut kar ı n hastal ı kları n ı taklit edebilir. Abdominal BT bulguları karakteristiktir. Hepsinden önemlisi, EA do ğ ru tan ı sı için bu durumun klinik ve radyolojik fark ı ndal ı ğ ı gereklidir.

Laparaskopik histerektomi sonrasında üreter zedelenmesi zannedilen epiploik apandisit olgusu

Epiploic appendagitis (EA), which is a rare cause of acute lower quadrant abdominal pain, is a benign self-limited, clinicopathological, and radiological entity. We describe a case of a 49-year old woman with acute abdominal pain mimicking ureter injury on day 7 after laparoscopic total hysterectomy. An abdominal examination revealed tenderness of the left lower quadrant. The abnormal laboratory test results were leukocytosis and elevated C- reactive protein levels. Abdominal ultrasonography revealed no significant abnormalities. Computerized Tomography (CT) revealed fat density lesions surrounded by inflammatory changes, which were the pathognomonic findings of the EA. EA results by torsion of the appendix or spontaneous thrombosis of an appendiceal draining vein or caused by nearby inflammatory processes. It can mimic a variety of acute abdominal diseases. Abdominal CT findings are characteristics. Most important of all; an accurate diagnosis of EA requires clinical and radiological awareness of this condition.

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