Epiploic appendagitis: an uncommon and nonsurgical cause of abdominal pain

Abstract

Epiploic appendagitis (AE) is arare cause of acute abdomen and is often misdiagnosed as other common causes of acute abdomen, such as acute appendicitis, cholecystitis or diverticulitis due to its low incidence and its nonspecific clinical picture. This study presents the clinical course of AE and typical radiological features for an early and correct diagnosis in order to emphasize the importance of an early and correct diagnosis of AE. This is aretrospective review of 43patients diagnosed with AE between June 2010 and September 2022 at the Charité- University Hospital Berlin, Campus Benjamin Franklin. The medical records were reviewed regarding clinical und radiological features, anatomical location of the AE und treatment methods. Atotal of 43patients (29male, 11female) were diagnosed with AE and almost all patients presented with abdominal pain, except in 8cases (18.6%). Specific findings in computer tomography (CT) with atypical picture of AE were found in 33patients (76.7%). AE was mostly localized in the left colon: 12 were found in the sigmoid colon (27.9%), 16 in the descending colon (37.2%) and 5 at the junction of the descending colon and the sigmoid colon (11.6%). Of the patients 28 (65.1%) were admitted for conservative treatment and the rest of the patients were treated as outpatients. No patient underwent surgery, all were treated with analgesics (NSAID) and 17patients received antibiotics in addition. AE is aself-limiting disease and acommon mimic of other serious causes of abdominal pain. Due to the emergence of the widespread use of imaging modalities, an early diagnosis of AE and a conservative approach as first choice of treatment in patients with AE could be established.