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Acute Epiploic Appendagitis: A Nonsurgical Abdominal Pain

Epiploic appendagitis is a relatively rare disease characterized by an inflammation of fat-filled serosal outpouchings of the large intestine, called epiploic appendices. Diagnosis of epiploic appendagitis is made challenging by the lack of pathognomonic clinical features and should therefore be considered as a potential diagnosis by exclusion first of all with appendicitis or diverticulitis which are the most important causes of lower abdominal pain. Currently, with the increasing use of ultrasound and computed tomography in the evaluation of acute abdominal pain, epiploic appendagitis can be diagnosed by characteristic diagnostic imaging features.

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 Epiploic Appendagitis: An Entity Frequently Unknown to Clinicians...

In secondary epiploic appendagitis, the epiploic appendage is inflamed because of another process, such as diverticulitis, appendicitis, pancreatitis, or cholecystitis. Management of secondary epiploic appendagitis is based on treatment of the primary abnormality.

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Abdominal pain caused by epiploic appendagitis

Computed tomography has higher sensitivity and specificity than ultrasonography for the diagnosis of epiploic appendagitis. The main computed tomography findings are a hyperattenuating ring sign and a central dot sign. The condition is self-limiting and can be managed using anti-inflammatory analgesics and usually improves within 14 days.

Acute appendagitis: emergency presentation and computed tomographic appearances

Acute epiploic appendagitis is an uncommon cause of abdominal pain. It is caused by torsion of an epiploic appendage or spontaneous venous thrombosis of a draining appendageal vein.1 The diagnosis of this condition primarily relies on cross‐sectional imaging and is made most often after computed tomography (CT).

Acute Epiploic Appendagitis and Its Mimics

Acute epiploic appendagitis most commonly manifests with acute lower quadrant pain. Its clinical features are similar to those of acute diverticulitis or, less commonly, acute appendicitis. The conditions that may mimic acute epiploic appendagitis at computed tomography (CT) include acute omental infarction, mesenteric panniculitis, fat-containing tumor, and primary and secondary acute inflammatory processes in the large bowel (eg, diverticulitis and appendicitis).

Epiploic appendagitis - a rare cause of acute lower abdominal pain

Epiploic appendagitis is a rare cause of acute to subacute lower quadrant abdominal pain. It has 2 subtypes: primary and secondary Epiploic appendagitis. Primary epiploic appendagitis is characterized by inflammation of the epiploic appendages caused by torsion or thrombosis of the draining vein of the appendage whereas secondary Epiploic appendagitis may occur in association with other inflammatory etiologies in the abdomen and pelvis. Due to its similarity to other causes of acute abdomen, patients with primary epiploic appendagitis often undergo unnecessary treatment with antibiotics and surgical intervention.

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

Abdominal CT is diagnostic. Treatment is conservative and focuses on pain management. Antibiotics are generally not indicated, except in rare cases in which colonic bacteria infiltrate and cause localized abscess formation or generalized peritonitis. Surgical intervention is only necessary in the uncommon event of secondary complications such as bowel obstruction. Symptoms generally self-resolve within a week.

Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen

Epiploic appendagitis is an uncommon clinical entity that is caused by ischemic infarction of an epiploic appendage due to torsion or thrombosis of the central draining vein. The clinical manifestations include acute abdominal pain, most commonly in the left lower quadrant. It is often misdiagnosed as acute diverticulitis or appendicitis. Most patients are afebrile and have a normal leukocyte count.

Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker

The emergence of computerized tomography (CT) as the gold standard imaging test in diagnostic dilemmas of acute abdominal pain has resulted in increased recognition and diagnosis of PEA. Upon confirmation, PEA is considered a self-limiting disease and is managed conservatively with analgesics, occasionally combined with nonsteroidal anti-inflammatory drugs (NSAIDS).

The Diagnostic Dilemma of Primary Epiploic Appendagitis and How to Establish a Diagnosis

Primary epiploic appendagitis (PEA) is a relatively uncommon, non-surgical situation that clinically mimics other conditions requiring surgery. In PEA, torsion and inflammation of an epiploic appendix results in localized abdominal pain. This condition may be clinically misdiagnosed, resulting in unnecessary surgical intervention.

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Radiopaedia

Epiploic appendagitis is a rare self-limiting ischemic/inflammatory process that affects the appendices epiploicae of the colon and may either be primary or secondary to adjacent pathology. This article pertains to primary (spontaneous) epiploic appendagitis. The term, along with omental infarction, is grouped under the broader umbrella term intraperitoneal focal fat infarction