Epiploic Appendagitis: Definition and Clinical Significance
Epiploic appendagitis is an inflammatory condition of the epiploic appendages, which are small, fat-filled peritoneal pouches that protrude from the serosal surface of the colon and can become inflamed due to torsion or thrombosis of their vascular supply.
Anatomy and Pathophysiology
Epiploic appendages are:
- Small, pedunculated, fat-filled outpouchings of peritoneum
- Located along the anti-mesenteric border of the colon (along the tenia coli)
- Extend from the cecum to the rectosigmoid junction
- Contain adipose tissue and a vascular stalk
- Typically 1.5-3.5 cm in size
Epiploic appendagitis occurs when:
- The appendage undergoes torsion (most common)
- Venous thrombosis develops in the draining vein
- Spontaneous inflammation occurs
Clinical Presentation
Epiploic appendagitis typically presents with:
- Acute onset of localized abdominal pain (most commonly left lower quadrant, but can occur anywhere along the colon)
- Pain that mimics acute diverticulitis or appendicitis
- Normal or slightly elevated white blood cell count
- Absence of fever in most cases
- Focal tenderness on physical examination
Diagnostic Features
The diagnosis is primarily made by CT imaging, which shows:
- Oval-shaped fat density lesion adjacent to the colon
- Hyperattenuating ring sign (inflammatory changes surrounding the appendage)
- Central dot sign (thrombosed vessel within the appendage)
- Mild localized bowel wall thickening
- Surrounding fat stranding
Clinical Significance
Epiploic appendagitis is important to recognize because:
- It is a benign, self-limiting condition
- It is frequently misdiagnosed as diverticulitis or appendicitis 1
- Misdiagnosis leads to unnecessary hospitalization, antibiotic use, and surgical interventions 2
- Correct diagnosis can prevent unwarranted surgeries and reduce healthcare costs
- It can be managed conservatively with NSAIDs and analgesics
Management
Treatment is conservative:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Pain management
- Symptoms typically resolve within 3-14 days
- No antibiotics required unless secondary infection
- No surgical intervention needed
Common Pitfalls
- Epiploic appendagitis is often overlooked in the differential diagnosis of acute abdominal pain
- The estimated rate of correct preoperative diagnosis is only about 2.5% 3
- It can occur on the vermiform appendix itself, further mimicking appendicitis 4
- Laboratory values are often normal, which may falsely reassure clinicians
- Lack of awareness of this condition leads to unnecessary interventions
Recognizing the characteristic CT findings of epiploic appendagitis is crucial for accurate diagnosis and appropriate management, preventing unnecessary hospitalizations and surgical procedures.