What are the Risk Factors and Symptoms of Epiploic Appendagitis?

Epiploic appendages are small sacs or pouches of fat that develop on the surface of the colon, projecting into the peritoneal cavity. They are largest and most abundant in the sigmoid and transverse colon. Their function is unknown, though researchers believe they are protective. Epiploic appendagitis occurs when these appendages become inflamed.

The symptoms of epiploic appendagitis are similar to a variety of other conditions, including diverticulitis and acute appendicitis. Primarily, the inflammation of the epiploic appendages causes a sharp, stabbing pain originating from the left or lower right areas of the abdomen. The pain may worsen during or after eating, coughing, bowel movements, or urination. Constipation or diarrhea are also possible, though uncommon.

Rarely, epiploic appendagitis may cause a peritoneal loose body, which is a free-floating mass of tissue that has calcified. Torsion, infarction, or fat necrosis can cause the epiploic appendages to detach from the colon. In some cases, the floating appendage can grow large enough to obstruct the bowels or bladder.

Torsion or twisting of the epiploic appendages is likely the most common cause of primary epiploic appendagitis. In some cases, blood clots of venous thrombosis are responsible. Most doctors recognize secondary epiploic appendagitis, which is the result of inflammation of the surrounding tissue. Others suggest this is a symptom of conditions like diverticulitis and does not properly describe epiploic appendagitis.

Experts have identified a few possible risk factors for epiploic appendagitis. The condition is mostly diagnosed in people in their twenties to fifties, with a mean age of diagnosis of 40 years. It appears to be around four times more frequent in males than females. Obesity, high abdominal adipose tissue, and frequent, strenuous exercise may also be risk factors for epiploic appendagitis.

Diagnosing epiploic appendagitis can be a difficult process. Many doctors tend to assume the symptoms are due to diverticulitis or acute appendicitis. Ultrasound and CT scans are the typical methods of diagnosing the condition. Healthy epiploic appendages do not usually appear on CT scans, unlike those that are inflamed.

Because the condition is so similar to other issues, experts are attempting to find ways to specifically confirm epiploic appendagitis. People with diverticulitis and appendicitis tend to have higher white blood cell counts, so if a person has the symptoms but their blood test shows typical levels, this may indicate epiploic appendagitis. MRI scans aren't usually used to diagnose abdominal pain but may be useful for ruling out other possibilities.

Epiploic appendagitis is a self-limiting condition, meaning it should resolve on its own without treatment. Doctors often choose to manage it conservatively with nonsteroidal anti-inflammatory drugs to help reduce inflammation and pain. While surgery is common for other acute abdominal diseases, it is only necessary in cases of epiploic appendagitis if the appendages break off — becoming peritoneal loose bodies — and need to be removed.

Researchers don't currently know how common epiploic appendagitis is. This is partially due to its rarity, though the fact that it resolves on its own, often without the patient seeing a doctor, also plays a role. Research shows that 2% to 7% of suspected acute diverticulitis cases and 0.3% to 1% of suspected acute appendicitis cases are actually epoploic appendagitis.

Since epiploic appendagitis resolves on its own in one or two weeks, the prognosis is almost always positive. The few negative outcomes stem from complications, such as blockages by peritoneal loose bodies. Despite the likelihood of recovery from this issue, people experiencing severe abdominal pain should visit a doctor, as conditions other than epiploic appendagitis — like diverticulitis and appendicitis — are more common and require surgery.