What Is Epiploic Appendagitis, What Causes It, And How Is This Condition Diagnosed And Treated?
On the outside wall of our colon or large intestine, there are about 100 or so protrusions made up of fat and tissues covering the colon. They could be as small as half a centimeter to three centimeters in length on the average, pointing perpendicularly away from the colon. These structures are out-pouching on the outside wall of the bowels, whose function or purpose is not known and are referred to as epiploic appendage. In some individuals, they have been recorded to be as long as 15cm! They have blood vessels supplying nutrient to them.
If, for any reason they become inflamed from the spread of a bowel infection, or they undergo torsion and twist along their long axis or if their blood supply gets blocked, they could lead to a terrible degree of pain.
As mentioned above, one of three events could lead to the development of inflammation of the epiploic appendage, or appendicitis epiploica. These are:
Appendicitis epiploica arising from torsion of the appndix epiploica, or blood vessle blockade or kinking are referred to as primary appendagitis, while those arising from spread of infection or inflammation somewhere else are referred to as secondary appendagitis.
Epiploic appendagitis is by no means a new concept. Contrary to what some in the medical field thinks, it is not "only recently been recognized". It is believed to have been first described in the 1850s and the name epiploic appendagitis was first used in 1956 by Lynn et al to describe this condition. There has been numerous documentations of this condition ever since and for some unknown reasons, many doctors have not embraced this important, though relatively uncommon cause of abdominal pain.
It is estimated that for every 100 diagnosis of appendicitis made, one of such cases is actually due to appendagitis, and for every 100 cases of suspected diverticulitis, up to 7 are due to inflammation of the epiploic appendage.
The most common way those with epiploic appendagitis present is with symptoms of acute lower right or left abdominal pain. Sometimes, a upper right side abdominal pain could be due to epiploic appendage inflammation or torsion. Over half (53%) of epiploic appendagitis occurs on the lower left abdominal region.
Conditions that can be mimicked by appendicitis epiploica include:
If you develop sudden onset upper or lower right or left side abdominal pain and have had tests and all the blood results and scans came back normal and yet still having pain, epiplopericolitis could be the cause.
The diagnosis of appendicitis epiploica is usually made from a combination of the story or history given by the patient of:
The diagnosis is usually made on CT these days, though in the past this condition is only diagnosed either during operation to removed a supposed bad appendix or at laparoscopy. The main findings on CT scan include fat inflammation around the colon, stranding of antimesenteric fat without associated bowel wall thickening. In many cases, these signs would be seen if a previously reported Ct scan is reviewed.
"As CT increasingly is used for the evaluation of acute abdomen,
radiologists are likely to see acute epiploic appendagitis and its
mimics more often. Recognition of these conditions on CT images will
allow appropriate management of acute abdominal pain and may help to
prevent unnecessary surgery." - Radiographics, a scientific journal of radiology of November - December 2005
Where facilities for CT scan does not exist, an abdominal ultrasound scan may show an "oval hyperechoic mass surrounded by a hypoechoic rim, without Doppler flow", reports the Canadian Medical Association Journal, CMAJ. 2010 June 15; 182(9): 939.
Epiploica appendagitis is a self limiting condition - that means that it gets better on its own, without the need for ant treatment. Usually, once the diagnosis is made, treatment involve the use of anti-inflammatory pain killers like ibuprofen and adequate fluid replacements and rest.
It is because this condition does not need treatment in greater percentage of cases, that it is important to make the right diagnosis and avoid unnecessary operation with its attendant surgical and anesthetic risks.
Very very rarely, an inflamed epiploic appendage may develop abscess, needing intravenous antibiotics and in severe cases surgery. But such cases are remotely rare enough that they are only mentioned for completeness sake.
Last Updated: 3rd December 2012.
Had a sudden onset upper or lower quadrant abdominal pain recently and had blood tests, scans etc and told nothing was found? Are you one of the few lucky ones to be told you had epiploic appendage inflammation, thus avoided an unnecessary surgical operation, or perhaps do you think this condition might be the cause of your abdominal pain? We would love to hear from you. Share your experience with other readers here!
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