From the Research
The most appropriate treatment plan for this 27-year-old man with epiploic appendagitis is nonsteroidal anti-inflammatory medication. Epiploic appendagitis is a self-limiting condition caused by torsion or thrombosis of the epiploic appendages (small fat-filled sacs attached to the colon) [ 1 ]. Despite presenting with symptoms that can mimic appendicitis, including right lower quadrant pain, this condition does not require surgical intervention or antibiotics. The patient's normal white blood cell count (9,800/µL is within normal range) also supports a non-infectious etiology.
Key Points to Consider
- NSAIDs such as ibuprofen 400-600 mg every 6-8 hours or naproxen 500 mg twice daily for 7-10 days will help manage the inflammation and pain [ 2 ].
- The patient can be discharged home with instructions to return if symptoms worsen or fail to improve within 1-2 weeks.
- Most cases resolve completely within 2 weeks with conservative management [ 3 ].
- Admission for observation is unnecessary given the benign nature of this condition, and surgical consultation would be excessive as this is not a surgical emergency [ 4 ].
- A systematic review of epiploic appendagitis cases found that most patients were treated conservatively, and surgical treatment was only necessary in a small number of cases [ 3 ].