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    Epiploic Appendagitis


    Last Updated Oct 10, 2023
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    By Kenneth Van Dewark, Armaghan (Army) Alam


    • Epiploic appendages or appendix epiploica are peritoneum-lined, fat-filled outpouchings arising from the surface of the colon attached to the external surface by vascular stalks that can become twisted, or stretched leading to venous infarction/necrosis.
    • Can mimic various underlying causes of abdominal conditions.
    • True incidence unknown, but 2 – 7% of patients suspected of having acute diverticulitis and 0.3-1% of patients suspected of having acute appendicitis have had acute appendagitis.
    • In a case series of 58 patients, 57% of cases were in the rectosigmoid and 26% in the ileocecum.
    • In emergency medicine, the significance of epiploic appendagitis is to differentiate this benign and self-limited condition from complex diverticulitis, appendicitis, or another intrabdominal emergency and  to minimize unnecessary invasive interventions.

    Diagnostic Process

    • Present with acute onset lower abdomen pain, most commonly in the left lower quadrant and is constant, dull, and does not radiate. They are typically afebrile and have no rebound tenderness on physical exam.
    • Typically, the pain will suddenly occur after movements that could potentially affect the underlying anatomy involved, such as postprandial activity or physical exercise.
    • Laboratory values are usually normal but may indicate a mildly elevated WBC/CRP.
    • Diagnosis is usually made by CT or abdominal ultrasound.
    • Classic CT finding is an oval, fat-dense 2 – 3 cm paracolic mass with surrounding inflammatory changes such as peritoneal thickening and fat stranding. Normal, non-inflamed epiploic appendages are not seen on CT.
    • Pathognomonic ultrasound findings – an oval-shaped, non-compressible, highly echogenic mass with a faint hypoechoic rim located directly beneath the area of greatest pain, without any visible central blood flow on color Doppler.

    Recommended Treatment

    • Epiploic appendagitis is benign and self-limited resolving spontaneously within 3 – 14 days.
    • Recurrence and complications such as abscess formation or obstruction are thought to be very rare.
    • Oral anti-inflammatory/analgesic medications and if necessary, short course of opioids.
    • Antibiotics and hospitalization are not required.
    • If there are complications or significant worsening of the symptoms, surgical consultation can be considered, however is the rarely needed

    Quality Of Evidence?


    There are a variety of studies available on this topic that have little variation in recommendations, but most studies are individual case reports or small case series. Therefore, the quality of this evidence is moderate.


    Related Information

    Reference List

    1. Schnedl, W. J., Krause, R., Tafeit, E., Tillich, M., Lipp, R. W., & Wallner-Liebmann, S. J. (2011). Insights into epiploic appendagitis. Nature reviews. Gastroenterology & hepatology8(1), 45–49. https://doi.org/10.1038/nrgastro.2010.189

    2. Rioux, M., & Langis, P. (1994). Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology191(2), 523–526. https://doi.org/10.1148/radiology.191.2.8153333

    3. Sajjad Z., Sajjad N., Friedman M., Atlas S.A. (2000). Primary epiploic appendagitis: an etiology of acute abdominal pain, Conn Med, 64(11):655-7.

    4. Singh A.K., Gervais D.A., Hahn P.F., Sagar P., Mueller P.R., Novelline R.A. (2005). Acute epiploic appendagitis and its mimics. Radiographics, 25(6):1521-34

    5. Radiographic imaging:  https://radiopaedia.org/articles/epiploic-appendage

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