Insights into epiploic appendagitis

Abstract

Epiploic appendagitis is a rare cause of abdominal pain. Diagnosis of epiploic appendagitis, although infrequent, is easily made with CT or ultrasonography in experienced hands. As reported in the literature, most patients with primary epiploic appendagitis are treated conservatively without surgery, with or without anti-inflammatory drugs. A small number of patients are treated with antibiotics and some patients require surgical intervention to ensure therapeutic success. Symptoms of primary epiploic appendagitis usually resolve with or without treatment within a few days. A correct diagnosis of epiploic appendagitis with imaging procedures enables conservative and successful outpatient management of the condition and avoids unnecessary surgical intervention and associated additional health-care costs. Gastroenterologists and all medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions, such as diverticulitis, cholecystitis and appendicitis. This article reviews epiploic appendagitis and includes discussion of clinical findings, pathophysiology, diagnosis and therapeutic possibilities.

An Uncommon Cause of Acute Abdominal Pain: Primary Epiploic Appendagitis in the Emergency Setting

“…Although epiploic appendages are present along the entire length of the large intestine, published reports suggest that 57% of PEA cases affect the rectosigmoid junction and 26% of cases affect the ileocecal region (Legome et al, 1999;Sangha et al, 2004;Hiller et al, 2000). An inflamed epiploic appendage in these locations produces a sharp, focal, non-migratory abdominal pain that can easily be mistaken for diverticulitis, appendicitis or acute cholecystitis (Boulanger et al, 2002;Schnedl et al, 2011). Patients are predominantly afebrile and do not usually have gastrointestinal symptoms such as nausea, vomiting, anorexia or changes in bowel habits (Legome et al, 2002;Sangha, 2004).…”

“…The diagnosis of PEA relies on abdominal CT or ultrasonography-diagnosis based on symptoms alone is essentially impossible (Schnedl et al, 2011). PEA can be diagnosed on abdominal CT images by the "hyperattenuating ring sign" (Vriesman, 1999;Rioux & Langis, 1994).…”

Is Outpatient Follow-Up of Epiploic Appendagitis with NSAIDs Alone and Noantibiotics Possible?

“…An average of 50 to 100 epiploic appendices is situated along the colonic wall, mostly under the serosa of transvers, descending and sigmoid colon especially. They can be more distinctive in the obese and people who lost weight rapidly [4] [5] [8].…”

“…They are prone to deformations as a result of their anatomic features. Epiploic appendices show symptoms mostly because of its torsion, ischemia or hemoragicinfarct [4] [5]. This acute abdomen presentation, which is defined as "primary epiploicappendagitis", occurs most commonly in the fourth decade of life [5].…”

Epiploic Appendagitis: A Benign Process at Risk of Unnecessary Hospitalization and Interventions

“…1 Treatment is conservative and focuses on pain management. 2 Antibiotics are generally not indicated 3 , except in rare cases in which colonic bacteria infiltrate and cause localized abscess formation or generalized peritonitis. 4 Surgical intervention is only necessary in the uncommon event of secondary complications such as bowel obstruction.…”