Epiploic appendagitis

Background

Anterior view of iliac colon, sigmoid colon, and rectum. Lumps of epiploic appendage fat visible on colon.

• Benign and self-limited condition of the epiploic appendages (fat-filled sacs along surface of colon and rectum)
• Acutely inflamed due to torsion or venous thrombosis
• Mimics Appendicitis or Diverticulitis
• Most often found on abdominal CT during abdominal pain workup
• More than half occur in rectosigmoid colon

Clinical Features

• Abdominal pain
• May develop fever and leukocytosis

Differential Diagnosis

RLQ Pain

• GI
  • Appendicitis
    • Perforated appendicitis
  • Peritonitis
  • Crohn's disease (terminal ileitis)
  • Diverticulitis (cecal, Asian patients)
  • Inguinal hernia
  • Mesenteric ischemia
  • Ischemic colitis
  • Meckel's diverticulum
  • Neutropenic enterocolitis (typhlitis)
• GU
  • Ectopic
  • Endometriosis
  • Kidney stone
  • Mittelschmerz
  • Ovarian cyst
  • Ovarian torsion
  • PID
  • Pyelonephritis
• Other
  • Abdominal aortic aneurysm
  • Epiploic appendagitis
  • Mesenteric lymphadenitis
  • Herpes zoster
  • Psoas abscess
  • Testicular torsion

Evaluation

Abdominal CT scan showing epiploic appendagitis (circle).

• CT abdomen with IV contrast

Management

• High dose ibuprofen
• Consider opioids
• Surgical intervention not routinely recommended

Disposition

• Outpatient follow-up.
• Although recurrence is common the disease is self limiting and not life threatening.

Prognosis

• Complete resolution normally within 3-14 days