Epiploic appendagitis, also known as appendicitis epiploica, hemorrhagic epiploitis, epiplopericolitis, or appendagitis, is a benign and self-limited condition of the epiploic appendages [1,2]. Inaccurate diagnosis can lead to unnecessary hospitalizations, antibiotic therapy, and surgical intervention [3-6]. This topic will review the clinical manifestations, diagnosis, and management of epiploic appendagitis.
Epiploic appendagitis is an ischemic infarction of an epiploic appendage caused by torsion or spontaneous thrombosis of the epiploic appendage central draining vein.
The true incidence of epiploic appendagitis is not known. However, epiploic appendagitis has been reported in 2 to 7 percent of patients who were initially suspected of having acute diverticulitis and in 0.3 to 1 percent of patients suspected of having acute appendicitis . Epiploic appendagitis occurs most commonly in the second to fifth decades of life with a mean age at diagnosis of 40 years. The incidence of epiploic appendagitis has been reported to be up to four times higher in men as compared with women [7-9]. Epiploic appendagitis can arise in any segment of the colon. In surgical case series, 57 percent of cases occur in the rectosigmoid, 26 percent in the ileocecum, 9 percent in the ascending colon, 6 percent in the transverse colon, and 2 percent in the descending colon [7,10,11]. Obesity and strenuous exercise may be risk factors for the development of epiploic appendagitis.
Epiploic appendages are small outpouchings of fat-filled, serosa-covered structures present on the external surface of the colon projecting into the peritoneal cavity. Each appendage encloses small branches of the circular artery and vein that supply the corresponding segment of the colon. Subserosal lymphatic channels either terminate in a lymph node within an appendage or loop through its base en route to mesenteric nodes.
On average, the adult colon has approximately 50 to 100 appendages. Epiploic appendages occur all along the entire colon but are more abundant and larger in the transverse and sigmoid colon. They are usually rudimentary at the base of the appendix [1,12]. The appendages vary considerably in size, shape, and contour. Most epiploic appendages are 1 to 2 cm thick and 2 to 5 cm long, although they are occasionally up to 15 cm . For unclear reasons, they are largest and most prominent in obese persons and in those who have recently lost weight [1,14]. Although the exact role of epiploic appendages is not known, they are presumed to serve a protective and defensive mechanism similar to that offered by the greater omentum and may have a role in colonic absorption. They may also act as a cushion, protecting colonic blood supply during peristalsis .