Wednesday, May 26, 2010

Epiploic Appendagitis Sucks

Say what?

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?

Nothing.

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.

31 comments:

Mrs Mom said...

Our Men Need To NOT Keep On With This Hospital Stuff.

HEal up quick RCC, and enjoy the Vicoden trip ;)

It has two side effects with Dear Husband-- makes him chatty (which is Funny. As. Hell.) and the other... welllllll let's just say it makes me blush ;)

K. Erickson said...

RCC sounds like a typical guy. Pale as a ghost, pain levels off the chart and goes to work. Reminds me of when I got pneumonia. Running a 105 temp, The Queen losing her mind wanting to take me to the hospital, and I'm like do whatever you want...just don't wake me up.

Finding Pam said...

What a night? I hope he is better soon. I am going to look that up. I think I might have it. LOL!

GunDiva said...

He's feeling marginally better, thank you all.

Boyles Family Farms said...

Hope it turns around soon!

Dual Mom said...

So this is something different than appendicitis? Never heard of it....

It's not often you hear someone rave about a hospital...must be a good one!

Aunt Crazy said...

OUCH OUCH OUCH! I hope he gets well soon!!!

Allenspark Lodge said...

Now that I've seen it in print, I understand what you were saying - appendagitis. It's really hard listening on my cell phone with MY mother yacking in the other ear because she didn't hear my phone ring...or me talking on it (and no, Rachel, she isn't deaf, just really good at tuning things out she doesn't want to hear; even her doc told her that.) I am so glad they figured it out - and sorry. We know about the 'tincture of time' thing. Remember Bill's booboo when Shadow ran over him? One of us will have to write that up for RTW!
Mom

Mad Woman said...

Oh crap that doesn't sound like fun. And they can't do anything for him except Vicodin? Yikes! Hope he's feeling better soon and that no one else needs to mess with 'your' boys.

SeAnne Hagemeyer said...

I was just diagnosed with EA, spent a night in the hospital on morphine and they sent me home with vicadin.

3 days later, STILL in pain, in fact getting worse!! how long til you feel better???

hurts like HELL when I try to get up, especially after laying down..

GunDiva said...

SeAnne - the Vicodin only took the edge off of the pain, didn't get rid of it. Took the pain from about 9-10 to a 7-ish.

It took 4-5 days before he noticed a decrease in pain and could sort of function. After that, the pain slowly resolved over a few weeks.

We were told that if the pain didn't resolve or got worse, that they could do a laproscopic excision of the inflammed appendage. Luckily, it didn't come to that, but it did take quite a while.

The good news (?) is that it typically never re-occurs.

Hope you start feeling better soon.

CHiLLZ said...

Thanks for writing this! The exact same thing happened to me. (So painful!) Nobody in the E.R. at our hospital had ever heard of it. Crazy stuff.

Anonymous said...

I was diagnosed with EA on July 27 after a CT scan. Spent a night in the hospital. I was put on antibiotics. The horrible pain has subsided as well as the horrible gloating. I still have some minor throbbing by my left ovary. I hope the inflammation isin't coming back. Has anyone had the laporascopic procedure done?

Anonymous said...

Found this blog on a random search. I also spent the morning in ER after 36 hours of this crazy pain...and was told EA. Taking the vicodin and it surely makes me sleepy - but just barely takes the pain down. I feel like I'm birthing a baby through my intestines! So hope tomorrow is a better day.

Anonymous said...

Found this blog after searching for info on EA. Just got diagnosed with EA after 2 days of horrific pain. So now on day 4, I'm finally starting to feel a little better. Went from an 8-9 on pain scale, now to probably a 6-7. Thanks for posting this blog!

Anonymous said...

i was just diagnosed with this after pre diagnosed with diverticulitis. your story is practically identical to mine. the pain can be unreal!!

thanks for posting.

mariah said...

I have this same thing... I was diagnosed with it last summer. It went away after a few weeks but It has come back and gone away off and on since then. It does suck.

Julie S said...

Interesting to read others experiences here in comments. When I suddenly developed pain that wouldn't allow me to stand up...I grinned and beared it for 3 awful days, went to ER and had CT with same EA diagnosis. I went home with the same sucky tincture of time and pain meds and couldn't stand tall for 10 more days! I googled (this was may 2009) and there was nothing from any individuals, just medical articles...so at least it is not being missed as much!). I was diagnosed with regular appendicitis back in February 2006 and when they got in there, the appendix wasn't infected but they removed it anyway...wonder if a seperate appendage had been inflammed then, too! Best of luck to all of you who've had EA!

Anonymous said...

I was diagnosed with EA on May 23, 2011.everything described above happened to me, the ER the physicians assistant's perplexion. Went home on Tylenol 3 and a promise it would be gone in 2 weeks. They found the EA on CT scan. Today is January 5, 2012. 8 months later and I just had laparoscopic surgery to remove it yesterday. Over the past 8 months, I have had 2 vaginal ultrasounds (ouch) and 2 more CT scans and one X-ray. Nothing showed up. I was referred to a general surgeon, he ordered an MRI and finally the EA was found! We set up surgery for Jan 4 and hear I am, minus my EA. I have 3 incisions: one right above my Neely button, one about 4 inches above my belly button and one about 3 inches below my belly button. I had to have general anesthesia so recovery was rough. I am sitting up now with ice on my biggest incision but I'm not gonna lie, IT HURTS. However it is the incision that hurts, the spot where the EA was does not hurt. Such a relief after being in pain since May! I missed work, I curled myself in the fetal position with the heating pad every night and took every over the counter medication. I don't like to use narcotics but the pain was so bad by mid-December I was prescribed Percocet. The doctor said I need 1 week off work and it has been les than 24 hours since they cut me. The pain is only unbearable when I stand up or sit down, so staying still is good.
I guess what I am saying is if you exhaust all diagnostics, surgery may be an option, even though the EA pain is "supposed" to go away in 2 weeks. The EA did not show up on a colonoscopy either. Get a second opinion if the pain doesn't go away.
By the way, I am a 35 year old female, not obese, not skinny, about average.everyoneis different but keep pursuing it if the pain doesn't go away! I'm hoping as soon as my incisions stop hurting me I will never have to grab my side in pain again.
Best of luck to you all who have this and it still causes you pain!

Sally said...

I am a 65 year old woman and after a week of right abdominal pain which I rated an 8, I went to the ER. Blood work showed no increase in white cells (no infection) and I had my appendix removed when I was 11. They hooked me up with an IV and gave me a total of 3 doses of morphine with no improvement in pain. Hours went by and they finally ordered a CT which showed EA. Talked to a surgeon and he explained everything and asked me about my medical history. I have a follow-up appointment with him this Monday to see if I'll need surgery or not. He prescribed pain pills (Percocet)and a week later the pain is much improved at a rating of 2 or 3. I hope it never comes back as the pain is just terrible. Good luck to all of you who have been diagnosed with EA.

Tara said...

My son was diagnosed with EA on 2-19-12. He has been inpatient twice since then and to the ER 3 times due inability to control the pain. Surgeons won't touch him, they keep saying it will work itself out. Well 9 days later and we were just in the ER again last night I am wondering how long this will really last. 1 doctor said a few days, another a couple weeks and the ER doctor last night said 4 to 6 weeks. Not what we wanted to hear since the kid can't function due to the pain and the pain meds. They are taking the edge off but he is at a constant 5 on the pain scale so not much wiggle room before we are back in the ER. Nice to find others that have been through this so I can prepare myself for the long hall.

Anonymous said...

I was diagnosed with EA a year ago after enduring 2 bouts of pain and a trip to the ER. Whie I am glad it's benign, not thrilled that the only solution is to "Control the pain". Have bouts on and off that last about 4-5 days each. Comes on suddenly. Hope RCC is ok.

Janet said...

Diagnosed with EA. severe pain. No appetite. I had one light snack a day for 4 days so far.
Does it help by not eating and giving colon a rest. I feel worse pain if even gas passes through that area.

Mari Lynn Smith said...

In June 2012 I rode the 'fast bus' to the ER with severe lower right pain. CT done and showed nothing but a left kidney mass. .I had a partial nephrectomy done in July '12 and mass proved to be a complex cyst. Still nothing on right side but pain. Nuc-med scan shows a Meckels Diverticulum with ectopic gastric mucosa. Hmmm. Surgeon wants a Colonoscopy done in September, one benign polyp removed. Yesterday I had a laproscopic appendectomy and discovered the EA so removed it too. Possible torsion causing original pain around the adhesions from my hysterectomy 5 years earlier. I'm doing great and feeling nearly zero pain today from surgery. Best of luck to y'all that have had similar situations.

Joantroj said...

Pain started on Friday, and became much worse on Sunday. I went to the ER yesterday convinced that something in my abdomen had ruptured! I had no fever, bloodworm was normal, identified EA on CAT scan. The ER doc was going to give me IV antibiotics as a precaution in case it was diverticulitis. My gastro dr returned a call to me at that very moment. He asked to talk to ER doc. My dr told the er doc not to give any antibiotics because it was EA. I was discharged and am seeing my gastro doctor today-he's the best! The pain is still bad, although I've had kidney stones and nothing can top that pain! I am sore everywhere i touch on my abdomen. Hoping this doesn't last long...

Kevin Lane said...

3/23/12 - Had worst stomach pain ever this morning, figured my appedix was about to rupture. Went to ER - they did a CT Scan to rule out Diverticultis and other serious abdominal issues. CT diagnosed me with EA. The pain meds don't help much - hoping it resolves itself in the 4 to 7 day window, like the DR suggested. Only thing that seems to help is lying totally motionless.

Sam Sukaton said...

I found your blog on a google search of EA - damn, it hurts! I'm on my fourth day and I feel like hell. I'm taking Tramadol (I'm a little scared of Vicodin) and it's managing the pain enough to work, but my left side is sore as all get-out.

Minor dietary changes can keep your guts from having a lot of pressure and thereby ease the pain a little - I've been told to eat more liquids, less protein just so my intestines don't have to work as much.

Poonam Kothare said...

Hi,

I was diagnosed with EA via CT scan on March 6, 2013 and the paid has not subsided. I have a colonoscopy on July 15. There is no medication for this as doctors do not know what causes it and how it happens. Welcome to the world of confusion.

Mireille Sohai said...

I just was diagnosed with this last night and I'm pregnant! this really sucks, but I appreciate the post.

Rakesh Thapar said...

I have Ea too. The pain is unbearable but I drink tart cherry juice it has helped so much in fighting the pain. Promgrante juice helps too you need antioxidants to repair the inflammation. Promgrante has the highest level try to get one thats gluten free. I am getting better day by day. Stay away from sugar stuff, and fried foods, and watch your salt intake. God bless hope you feel better soon.

Rakesh Thapar said...

I am going through Ea too. Tart cherry juice helps a lot with the pain. It brings it down so much sometimes I can't even feel the pain. Plus drink promgrante juice three times a day get your body all the antioxidants it's needs to feel better. It has helped a lot.