Epiploic Appendagitis

What is epiploic appendagitis?

Epiploic appendagitis is a rare cause of sudden abdominal pain. The name means “inflammation of an epiploic appendage.” Epiploic appendages are small pieces of fat that attach to and hang from the outside of your large intestine (colon). If one of them gets twisted, it can cut off its own blood supply.

This causes inflammation in the appendage and abdominal pain for you. Typically, the pain comes on abruptly and you can pinpoint the spot. But because it’s relatively uncommon, epiploic appendagitis is often misdiagnosed as one of the more common causes of acute, focal abdominal pain, like:

• Appendicitis (inflamed appendix).
• Cholecystitis (inflamed gallbladder).
• Diverticulitis (inflamed pocket in your colon lining).

How common is epiploic appendagitis?

We don’t know exactly how common it is because it’s likely underdiagnosed. Researchers estimate that 1% of hospital visits for acute abdominal pain are due to epiploic appendagitis. About 5% of people diagnosed with diverticulitis or appendicitis have been found to have epiploic appendagitis instead.

How serious is epiploic appendagitis?

Epiploic appendagitis itself isn’t serious, although it may be mistaken for other, more serious conditions. Unlike these other conditions, epiploic appendagitis usually goes away by itself. The affected epiploic appendage will eventually calcify and break off, which stops the inflammation and pain.

What causes epiploic appendagitis?

Causes of epiploic appendagitis can be primary or secondary. Primary causes happen in the appendage itself. Secondary causes start somewhere else and spread to your appendage. This is less common.

The primary causes are:

• Torsion. Most of the time (75%), primary epiploic appendagitis happens when an appendage gets bent or twisted. This torsion is enough to cut off blood flow and cause an infarction (the blood can’t get to the part of your body that needs it).
• Thrombosis. Rarely, a blot clot might obstruct a vein in one of the appendages.

Secondary causes include:

• Infection that spreads from somewhere else.
• Compression of the appendage from swelling in the tissues around it.

What are the risk factors for epiploic appendagitis?

Some research indicates that epiploic appendagitis might be more common with:

• Obesity.
• Hernias.
• Diverticulosis.
• Strenuous exercise.
• Middle age (40s to 50s).
• People assigned male at birth (AMAB).

What are the symptoms of epiploic appendagitis?

The primary symptom is abdominal pain, usually in one spot. It comes on suddenly and may last several weeks. Since there are more appendages on the lower parts of your colon, epiploic appendagitis usually occurs there. Three in 4 people describe lower abdominal pain, and more than half say it’s on the left side.

People also describe the pain as:

• Sharp.
• Constant.
• Intense.

It might feel worse when you:

• Cough.
• Stretch.
• Breathe deeply.

Additional signs may include:

• Guarding. Reflexively protecting that area, like being stiff, flinching or bracing.
• Rebound tenderness. Your pain worsens when your provider removes pressure from the area.
• A palpable mass. Sometimes, the appendage is swollen enough to feel from the outside.

These symptoms resemble several other, more common conditions. But appendicitis, cholecystitis and diverticulitis often include other symptoms, as well — like fever, nausea and vomiting. Your provider might suspect epiploic appendagitis if you have this type of abdominal pain but don’t have other symptoms.

How is epiploic appendagitis diagnosed?

A radiologist can spot epiploic appendagitis on an abdominal ultrasound or CT scan (computed tomography scan). A healthy epiploic appendage usually won’t show up in these images, but an inflamed one stands out due to the fluid inside, which makes it brighter. It looks like an oval-shaped mass located right at the source of the pain.

What is the best treatment for epiploic appendagitis?

Healthcare providers begin by offering nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. They’ll offer additional pain relief if you need it. Most people improve quickly with medication. If you don’t, rarely, your provider might need to remove the appendage in surgery.

How long does epiploic appendagitis usually take to heal?

Even without treatment, symptoms of epiploic appendagitis rarely last longer than a week. They might last up to four weeks in some circumstances. With medication, symptoms often improve within days.

When does epiploic appendagitis treatment require surgery?

Surgery for epiploic appendagitis is extremely rare. But if your symptoms don’t improve, or if your diagnosis is still in doubt, your provider might need to look inside your abdomen for the cause of your ongoing pain. They can do this through a minimally invasive surgical procedure called a laparoscopy.

A surgeon makes three or four small (half an inch) scattered incisions in your abdomen and inserts a tiny camera called a laparoscope. The laparoscope projects images to a screen. A laparoscopic surgeon uses these small incisions to operate, using long, narrow tools. They can remove the appendage this way.

What is the outlook for epiploic appendagitis?

Epiploic appendagitis can be painful and alarming, but in general, it isn’t anything to worry about. Unlike your appendix, gallbladder or diverticula, an epiploic appendage has no risk of rupturing from inflammation. Usually, the inflammation burns out, the appendage dies, and it’s all over within a week.

Is epiploic appendagitis related to cancer?

There’s no known connection between epiploic appendagitis and cancer.

What foods should I eat or avoid to prevent epiploic appendagitis?

There’s no known connection between epiploic appendagitis and your eating habits.

A note from Cleveland Clinic

If epiploic appendagitis ever happens to you, it’ll likely be the first and last time you hear about it. The sudden pain can be scary, and you might head to the emergency room expecting surgery for something more serious. But treatment for epiploic appendagitis is simple, and surgery is rarely necessary. You’ll come home with an oddity of a healthcare story to share with everyone else who’s never heard of it.