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Insights into epiploic appendagitis

Abstract

Epiploic appendagitis is a rare cause of abdominal pain. Diagnosis of epiploic appendagitis, although infrequent, is easily made with CT or ultrasonography in experienced hands. As reported in the literature, most patients with primary epiploic appendagitis are treated conservatively without surgery, with or without anti-inflammatory drugs. A small number of patients are treated with antibiotics and some patients require surgical intervention to ensure therapeutic success. Symptoms of primary epiploic appendagitis usually resolve with or without treatment within a few days. A correct diagnosis of epiploic appendagitis with imaging procedures enables conservative and successful outpatient management of the condition and avoids unnecessary surgical intervention and associated additional health-care costs. Gastroenterologists and all medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions, such as diverticulitis, cholecystitis and appendicitis. This article reviews epiploic appendagitis and includes discussion of clinical findings, pathophysiology, diagnosis and therapeutic possibilities.

Key Points

  • Epiploic appendagitis is a rare cause of abdominal pain and may mimic other acute and subacute conditions

  • Diagnosis is made with CT, which reveals a characteristic lesion usually located in one of the lower abdominal quadrants, or ultrasonography, which reveals a hyperechogenic paracolic oval-shaped mass

  • Most patients recover with conservative nonsurgical management with or without the use of anti-inflammatory drugs

  • A correct diagnosis of epiploic appendagitis enables conservative, outpatient management thereby avoiding unnecessary surgical intervention and associated additional health-care costs

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Figure 1: Characteristic abdominal CT findings of epiploic appendagitis in a 40-year-old patient.
Figure 2: A transverse view of an abdominal CT of a 78-year-old patient with epiploic appendagitis.
Figure 3: An ultrasonography image of a 44-year-old patient with epiploic appendagitis.

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W. J. Schnedl, R. Krause and R. W. Lipp researched data for the article and discussed the content of the manuscript together with E. Tafeit and S. J. Wallner-Liebmann. The article was written by W. J. Schnedl, M. Tillich and S. J. Wallner-Liebmann. All authors contributed equally to review and/or editing of the manuscript before submission.

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Correspondence to Wolfgang J. Schnedl.

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Schnedl, W., Krause, R., Tafeit, E. et al. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol 8, 45–49 (2011). https://doi.org/10.1038/nrgastro.2010.189

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