Wednesday, May 26, 2010
Epiploic Appendagitis Sucks
Epiploic appendages (or appendices) are fat pouches from the peritoneum (the sac lining the abdominal cavity) that are just a few centimeters long and are are commonly found along the transverse and sigmoid colon. I vaguely remember learning about them in anatomy a million years ago in college. They weren't important, so I put them out of my mind.
Fast forward from college anatomy to last night. RCC's been complaining of left lower quadrant pain since Sunday. He'd been working on his Jeep Saturday and there is *nothing* in the left lower quadrant of males other than intestines, so we both chalked up his pain to a pulled abdominal muscle.
By Tuesday morning, his pain had increased to a 7 out of 10 (10 being "please put a bullet in my brain" pain), but he went to work anyway and I told him we'd go to the doctor when he got home from work.
He pulled into the college about 3pm yesterday, pale as a ghost. It was easy to tell that his pain had gotten much worse. So much worse that he didn't argue with me about going to Urgent Care. By this time, I'm thinking hernia, but the pain was totally and completely in the wrong area for a hernia. His pain was more where an ovary in a female would be, and that's no where near a typical hernia site.
They got us in quickly at Urgent Care; the doc took one look at him, poked and prodded around and immediately sent us to the ER for blood work and a CT scan. She was thinking that maybe RCC had diverticulitis, despite his age. Diverticulitis is more commonly seen in older patients, not young 'uns in their mid-30s.
So, off to the ER we went, paperwork in hand. They processed us fairly quickly and the Physician Assistant came in to see us. She poked and prodded around on RCC, quickly raising his pain level with her manipulations. She tried to hide it, but she was perplexed, too. Left lower quadrant pain in a male that *probably* wasn't a hernia or diverticulitis.
RCC's pain, despite IV Morphine Sulfate, was hovering around a 4 while he was laying down (unless I was making him laugh - I tell you, I was one witty beast last night, but now can't remember anything I said).
Side note: I have to tell you, I wasn't happy with someone else messing around with "my" boys. I've been in medicine a long time and I understand how to check for an inguinal hernia, but that didn't mean I liked it one bit that another woman was telling my hubby to drop his drawers and doing the ole turn-and-cough routine. When she left and I told RCC that, he burst out laughing and crying. Laughing because I didn't like it and crying because laughing jumped his pain to a 10.
Even after the hernia check was negative, she was still concerned about it. Abdominal wall hernias aren't unheard of, after all. His symptoms matched both an abdominal hernia and diverticulitis. Off to CT we went.
I've sent lots of patients to CT; have scheduled them, done the allergy checklist, have peeked over my doc's shoulder to look at them, but I've never actually seen a CT being done. That is some cool-ass shit. It's like Star Trek medicine and didn't take hardly any time at all.
Back to the room we went to await the CT results.
Side note #2: I love my Nook. I took it along to the hospital with me and the three hours or so we spent there just flew by. I may be doing a review of my Nook (codename: Eloise) soon.
When the PA came back with the diagnosis, it was obvious that she had to look it up, too. Epiploic Appendagitis. Inflammation of an epiploic appendage. Presents just like diverticulitis (well, no duh), but without the infection and the outpouching of the colon wall.
Great. We know what is is now, what do we do about it?
Tincture of time and Vicodin for pain.
Should resolve on its own.
Good and bad news. Good news: no scalpel, no surgery. Bad news: tincture of time sucks.
So does epiploic appendagitis.
Side note #3: I completely understand why PVHS has won so many awards in recent years. The care was awesome.