Epiploic appendagitis: An overlooked cause of acute abdominal pain

Abstract

BACKGROUND: Epiploic appendagitis is a rare, often underrecognized cause of acute abdominal pain. Misdiagnosis can lead to unnecessary hospitalization, antibiotic use, or surgical intervention. Advances in imaging have improved the recognition of this self-limiting condition, but clinical awareness remains critical. AIM: To provide a comprehensive update on the epidemiology, anatomy, pathogenesis, clinical presentation, diagnostic strategies, differential diagnosis, and management of epiploic appendagitis, emphasizing its distinguishing features from other causes of acute abdomen. METHODS: A review of the literature was conducted, focusing on the clinical characteristics, imaging findings, differential diagnoses, and evidence-based management strategies for epiploic appendagitis. RESULTS: Epiploic appendagitis typically presents with acute, localized, non-radiating abdominal pain without significant systemic symptoms. Diagnosis is heavily reliant on imaging, with computed tomography (CT) being the gold standard. Hallmark CT findings include a small, fat-density ovoid lesion adjacent to the colon, with the usual characteristic ring and dot signs. Differential diagnoses include mainly diverticulitis, appendicitis, omental infarction, and many other causes. Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation, reserving surgical intervention for rare, complicated cases. CONCLUSION: Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions. Increased clinician awareness, coupled with judicious use of imaging, facilitates timely diagnosis and appropriate management, ensuring optimal patient outcomes.