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Epiploic appendagitis
From WikEM
Contents
Background
- Benign and self-limited condition of the epiploic appendages (fat-filled sacs along surface of colon and rectum)[1]
- 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
- Appendicitis
- Abdominal aortic aneurysm
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Ectopic
- Endometriosis
- Epiploic appendagitis
- Herpes zoster
- Inguinal hernia
- Ischemic colitis
- Meckel's diverticulum
- Mesenteric lymphadenitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Kidney stone
- Neutropenic enterocolitis (typhlitis)
Evaluation
- CT abdomen with IV contrast
Management
- High dose ibuprofen
- Consider narcotic medication (usually start with acetaminophen/codeine)
- Surgical intervention not routinely recommended
Disposition
- Outpatient followup.
- Although recurrence is common the disease is self limiting and not life threatening.
Prognosis
- Complete resolution normally within 3-14 days
References
- ↑ Schnedl WJ, et al. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 2011; 8:45-59.
