From the Research
The initial management for a patient with epiploic appendicitis is conservative treatment with oral non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600 mg three times daily or naproxen 500 mg twice daily for 7-10 days, along with rest and reassurance. Antibiotics are not necessary as this is a non-infectious, inflammatory condition 1. Patients should be advised to maintain adequate hydration and may use acetaminophen 500-1000 mg every 6 hours as needed for breakthrough pain. Most cases resolve spontaneously within 1-2 weeks with this approach. Surgery is rarely indicated and should be reserved only for complications such as abscess formation, intestinal obstruction, or peritonitis. This conservative management strategy is appropriate because epiploic appendicitis is a self-limiting condition caused by torsion or thrombosis of the appendices epiploicae (small fat-filled sacs attached to the colon), resulting in localized inflammation and pain that mimics other acute abdominal conditions 2, 3, 4, 5. Some key points to consider in the management of epiploic appendicitis include:
- The use of imaging modalities such as CT to confirm the diagnosis 3, 1
- The importance of differentiating epiploic appendicitis from other acute abdominal conditions such as appendicitis or diverticulitis 2, 4
- The role of NSAIDs in controlling pain and reducing inflammation 5
- The need for follow-up to ensure symptom resolution and to monitor for potential complications 4. Follow-up should be arranged within 1-2 weeks to ensure symptom resolution, with instructions to return sooner if symptoms worsen.