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 .
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 . 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 .
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.
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.