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Epiploic appendagitis

INTRODUCTION

Epiploic appendagitis (EA), also known as appendicitis epiploica, hemorrhagic epiploitis, epiplopericolitis, or appendagitis, is a benign and self-limited condition of the epiploic appendages that occurs secondary to torsion or spontaneous venous thrombosis of a draining vein [1,2]. EA occurs most commonly in the second to fifth decades of life; the mean age in several reports was approximately 38 years and there was a similar incidence among men and women. Complete resolution without surgical intervention usually occurs between 3 to 14 days [3-6]. Inaccurate diagnosis can lead to unnecessary hospitalizations, antibiotic therapy, and surgical intervention [7].

ANATOMY

Epiploic appendages are small outpouchings of fat-filled, serosa-covered structures present on the external surface of the colon projecting into the peritoneal cavity. The appendages are situated along the entire colon and are more abundant and larger in the transverse and sigmoid colon. Approximately 50 to 100 appendages are present in the colon of an average person. They are usually rudimentary at the base of the appendix [1,8].

The epiploic appendages vary considerably in size, shape, and contour. For unclear reasons, they are largest and most prominent in obese persons and in those who have recently lost weight [1,9]. The average length of the epiploic appendage is 3 cm, although they are occasionally up to 15 cm [10]. They are presumed to serve a protective and defensive mechanism similar to that offered by the greater omentum. They may also act as a protective cushion during peristalsis [1].

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.

PATHOPHYSIOLOGY

Epiploic appendagitis (EA) is usually caused by torsion, which occurs when the appendage is abnormally long and large. The vein, which is longer than the artery by virtue of its tortuous course, alters the anatomy such that the pedicle is predisposed to twisting. Spontaneous venous thrombosis of a draining vein can also predispose to twisting of the appendage pedicle. Gradual torsion of the appendages can result in chronic inflammation with minimal or no symptoms. In contrast, acute strangulation is associated with the development of symptoms.

    

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Literature review current through: Sep 2014. | This topic last updated: Feb 1, 2013.
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References
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  1. Pines BR, Beller J. Primary torsion and infarction of the appendices epiploicae. Arch Surg 1941; 42:775.
  2. DOCKERTY MB, LYNN TE, WAUGH JM. A clinicopathologic study of the epiploic appendages. Surg Gynecol Obstet 1956; 103:423.
  3. Desai HP, Tripodi J, Gold BM, Burakoff R. Infarction of an epiploic appendage. Review of the literature. J Clin Gastroenterol 1993; 16:323.
  4. Rioux M, Langis P. Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology 1994; 191:523.
  5. Lee YC, Wang HP, Huang SP, et al. Gray-scale and color Doppler sonographic diagnosis of epiploic appendagitis. J Clin Ultrasound 2001; 29:197.
  6. Legome EL, Belton AL, Murray RE, et al. Epiploic appendagitis: the emergency department presentation. J Emerg Med 2002; 22:9.
  7. Rao PM, Rhea JT, Wittenberg J, Warshaw AL. Misdiagnosis of primary epiploic appendagitis. Am J Surg 1998; 176:81.
  8. Patterson DC. Appendices epiploicae and their surgical significance with report of three cases. N Engl J Med 1933; 209:1255.
  9. Ghahremani GG, White EM, Hoff FL, et al. Appendices epiploicae of the colon: radiologic and pathologic features. Radiographics 1992; 12:59.
  10. Linkenfeld F. Deutsche Ztschr f Chir 1908; 92:383.
  11. Macari M, Laks S, Hajdu C, Babb J. Caecal epiploic appendagitis: an unlikely occurrence. Clin Radiol 2008; 63:895.
  12. Adler JE. Torsion of an appendix epiploica in a bilocular hernial sac. Lancet 1908; 172:377.
  13. Klingenstein P. Some phases of the pathology of the appendices epiploicae. Surg Gynecol Obstet 1924; 38:376.
  14. ROSS JA, McQUEEN A. Peritoneal loose bodies. Br J Surg 1948; 35:313.
  15. McGeer PL, McKenzie AD. Strangulation of the appendix epiploica: A series of 11 cases. Can J Surg 1960; 3:252.
  16. Shehan JJ, Organ C, Sullivan JF. Infarction of the appendices epiploicae. Am J Gastroenterol 1966; 46:469.
  17. Carmichael DH, Organ CH Jr. Epiploic disorders. Conditions of the epiploic appendages. Arch Surg 1985; 120:1167.
  18. Mollà E, Ripollés T, Martínez MJ, et al. Primary epiploic appendagitis: US and CT findings. Eur Radiol 1998; 8:435.
  19. Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics 2000; 20:399.
  20. Rao PM, Rhea JT, Novelline RA, et al. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 1998; 338:141.
  21. Rao PM, Wittenberg J, Lawrason JN. Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology 1997; 204:713.
  22. Patel VG, Rao A, Williams R, et al. Cecal epiploic appendagitis: a diagnostic and therapeutic dilemma. Am Surg 2007; 73:828.
  23. Rao PM. CT of diverticulitis and alternative conditions. Semin Ultrasound CT MR 1999; 20:86.
  24. Singh AK, Gervais DA, Hahn PF, et al. CT appearance of acute appendagitis. AJR Am J Roentgenol 2004; 183:1303.
  25. Deceuninck A, Danse E. Primary epiploic appendagitis: US and CT findings. JBR-BTR 2006; 89:225.
  26. Ng KS, Tan AG, Chen KK, et al. CT features of primary epiploic appendagitis. Eur J Radiol 2006; 59:284.
  27. Subramaniam R. Acute appendagitis: emergency presentation and computed tomographic appearances. Emerg Med J 2006; 23:e53.
  28. Sirvanci M, Balci NC, Karaman K, et al. Primary epiploic appendagitis: MRI findings. Magn Reson Imaging 2002; 20:137.
  29. van Breda Vriesman AC, Puylaert JB. Epiploic appendagitis and omental infarction: pitfalls and look-alikes. Abdom Imaging 2002; 27:20.
  30. Danse EM, Van Beers BE, Baudrez V, et al. Epiploic appendagitis: color Doppler sonographic findings. Eur Radiol 2001; 11:183.
  31. Görg C, Egbring J, Bert T. Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall Med 2009; 30:163.
  32. Legome EL, Sims C, Rao PM. Epiploic appendagitis: adding to the differential of acute abdominal pain. J Emerg Med 1999; 17:823.
  33. Vinson DR. Epiploic appendagitis: a new diagnosis for the emergency physician. Two case reports and a review. J Emerg Med 1999; 17:827.
  34. Puppala AR, Mustafa SG, Moorman RH, Howard CH. Small bowel obstruction due to disease of epiploic appendage. Am J Gastroenterol 1981; 75:382.