What is appendagitis (inflammation of the appendix)?

From the Guidelines

Appendagitis, also known as epiploic appendagitis, is a self-limiting condition that typically resolves on its own within 3-14 days without specific treatment, and management primarily involves pain control with over-the-counter NSAIDs. The condition affects the small fat-filled pouches (epiploic appendages) attached to the outer wall of the colon, causing sudden, localized abdominal pain, most commonly in the lower left or right quadrant, which can mimic other serious conditions like appendicitis or diverticulitis 1. Some key points to consider in the management of appendagitis include:

• Pain control with over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (250-500mg twice daily) for 5-7 days
• Rest and applying heat to the affected area may provide additional comfort
• Patients should stay hydrated and follow a bland diet until symptoms improve
• Medical attention should be sought for initial diagnosis to rule out more serious conditions, as appendagitis is typically diagnosed through CT imaging 1 The condition occurs when blood supply to an epiploic appendage becomes compromised, causing inflammation and pain, but rarely leads to complications and doesn't typically require antibiotics or surgical intervention unless complications develop. In terms of antibiotic therapy, there is no recommendation for the use of antibiotics in the treatment of appendagitis, unless complications develop, as stated in the guidelines for the management of acute appendicitis, which suggests that antibiotics are not necessary for uncomplicated appendicitis 1. It's worth noting that the provided evidence is mostly related to acute appendicitis, and not specifically to appendagitis, but the general principles of management can be applied to both conditions. Overall, the management of appendagitis should focus on pain control, rest, and hydration, with medical attention sought for initial diagnosis and to rule out more serious conditions.

From the Research

Definition and Diagnosis of Appendagitis

• Appendagitis, also known as acute appendicitis, is a common abdominal surgical emergency worldwide, with an annual incidence of 96.5 to 100 cases per 100,000 adults 2.
• The clinical diagnosis of acute appendicitis is based on history, physical examination, laboratory evaluation, and imaging, with classic symptoms including vague periumbilical pain, anorexia/nausea/intermittent vomiting, migration of pain to the right lower quadrant, and low-grade fever 2.
• The diagnosis of acute appendicitis is made in approximately 90% of patients presenting with these symptoms 2.

Treatment Options for Appendagitis

• Laparoscopic appendectomy remains the most common treatment for acute appendicitis, but increasing evidence suggests that broad-spectrum antibiotics can successfully treat uncomplicated acute appendicitis in approximately 70% of patients 2.
• The choice of treatment depends on the presentation of the patient, with uncomplicated disease potentially managed with antibiotics alone, and complicated disease requiring timely surgical intervention 3.
• Recent studies have demonstrated that nonoperative management of uncomplicated appendicitis without fecalith can be managed with antibiotics alone 3.

Surgical Management of Appendagitis

• Laparoscopic appendectomy is considered the "state of the art" in the treatment of appendicitis, with a reported rate of up to 86% in recent literature 4.
• Open appendectomy remains a safe and effective technique, while single port laparoscopic appendectomy and NOTES-appendectomy are also available options, although less widespread 4.
• A prospective study found that laparoscopic appendectomy offered several significant advantages in postoperative recovery over open appendectomy, including shorter hospital stay, better postoperative pain recovery, and earlier return to normal activities 5.

Comparison of Treatment Outcomes

• A systematic review found that antibiotics may be associated with higher rates of unsuccessful treatment, but may reduce wound infections, and that a third of participants initially treated with antibiotics required subsequent appendectomy or two-thirds avoided surgery within one year 6.
• The review also found that it is uncertain whether there is any difference in mortality, complications, or length of hospital stay between antibiotic treatment and appendectomy, due to very low-certainty evidence 6.