Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2015; 21(35): 10242-10245
Published online Sep 21, 2015. doi: 10.3748/wjg.v21.i35.10242
Co-occurrence of carbohydrate malabsorption and primary epiploic appendagitis
Wolfgang J Schnedl, Peter Kalmar, Harald Mangge, Robert Krause, Sandra J Wallner-Liebmann
Wolfgang J Schnedl, Practice for General Internal Medicine, A-8600 Bruck, Austria
Peter Kalmar, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, A-8036 Graz, Austria
Harald Mangge, Clinical Institute for Medical and Chemical Laboratory Diagnosis, MUG Coordinator BioTechMed Graz, Medical University of Graz, A-8036 Graz, Austria
Robert Krause, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria
Sandra J Wallner-Liebmann, Institute of Pathophysiology, Centre for Molecular Medicine, Medical University of Graz, A-8010 Graz, Austria
Author contributions: Schnedl WJ and Kalmar P designed the research; Schnedl WJ, Kalmar P, Krause R and Mangge H performed the research; Schnedl WJ, Kalmar P, Krause R, Mangge H and Wallner-Liebmann SJ assisted with the manuscript revision and approved the final version; Schnedl WJ and Kalmar P wrote the paper.
Institutional review board statement: This case report is performed in accordance with the Declaration of Helsinki and the recommendations of the local Ethics Committee.
Informed consent statement: The study participant provided informed written consent.
Conflict-of-interest statement: The authors declare no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Harald Mangge, Professor, Clinical Institute for Medical and Chemical Laboratory Diagnosis, MUG Coordinator BioTechMed Graz, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria. harald.mangge@klinikum-graz.at
Telephone: +43-316-38583340
Received: January 13, 2014
Peer-review started: January 15, 2014
First decision: January 22, 2015
Revised: February 5, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: September 21, 2015
Abstract

Unspecific abdominal complaints including bloating and irregular bowel movements may be caused by carbohydrate malabsorption syndromes, e.g., lactose and fructose malabsorption. These symptoms were investigated with hydrogen (H2) breath tests and correlated to carbohydrate malabsorption. During performing these H2-breath tests the patient presented with an acute, localized, non-migratory pain in the left lower abdominal quadrant. Primary epiploic appendagitis is a rare cause of abdominal acute or subacute complaints and diagnosis of primary epiploic appendagitis (PEA) is made when computed tomography reveals a characteristic lesion. We report on a patient with co-occurrence of lactose and fructose malabsorption, which was treated successfully with a diet free of culprit carbohydrates, with PEA recovering without medication or surgical treatment within few days. Since the abdominal unspecific symptoms had been present for months, they appeared not to be correlated to the acute localized abdominal pain, therefore we speculate on a random co-occurrence of combined carbohydrate malabsorption and PEA.

Keywords: Carbohydrate malabsorption, Fructose malabsorption, Lactose malabsorption, Primary epiploic appendagitis, Computed tomography

Core tip: The symptoms of unspecific abdominal complaints were investigated with hydrogen breath tests and correlated to lactose and fructose malabsorption. During performing these H2-breath tests the patient presented with an acute abdominal pain. Primary epiploic appendagitis (PEA) is a rare cause of abdominal acute complaints and diagnosis of PEA is made when computed tomography reveals a characteristic lesion. Since the abdominal unspecific symptoms had been present for months, they appeared not to be correlated to the acute localized abdominal pain, therefore we speculate on a random co-occurrence of combined carbohydrate malabsorption and PEA.