Table of ContentsView AllTable of ContentsWhat Is It?CausesSymptomsRisk FactorsDiagnosisTreatmentComplications and PrognosisLong-Term Outlook
Table of ContentsView All
View All
Table of Contents
What Is It?
Causes
Symptoms
Risk Factors
Diagnosis
Treatment
Complications and Prognosis
Long-Term Outlook
Epiploic appendagitis(EA) is a rare inflammatory condition that causes sharp stomach or abdominal pain. Only about 1% of adults who seek medical attention for abdominal pain are diagnosed with EA.This condition typically heals itself and resolves with conservative treatment in roughly five to seven days.
Unlike much more serious causes of lower abdominal pain that often requiresurgeryorantibiotics, such asappendicitisanddiverticulitis, epiploic appendagitis treatment is usually limited to taking over-the-counter (OTC) nonsteroidal anti-inflammatory medication (NSAIDs) to alleviate symptoms.
This article explains the causes, symptoms, diagnostic methods, and treatment options for epiploic appendagitis.
Kinga Krzeminska / Getty Images
Anatomy and Function of Epiploic Appendages
Epiploic appendages are small folds ofperitoneum, a thin sheet of tissue that lines the abdomen’s inner walls and covers the abdominal organs. They are also called omental appendices, fatty appendices of the colon, or appendices epiploicae. This fatty tissue creates a membrane that drapes over the abdominal cavity. Their exact function is unknown, but they are thought to provide cushioning and serve as areas for blood to collect.
What Causes Epiploic Appendagitis?
Primary Epiploic Appendagitis
Secondary Epiploic Appendagitis
Symptoms of Epiploic Appendagitis
Epiploic appendagitis typically causes sudden, sharp, non-radiating pain in the abdomen’s lower left quadrant with tenderness in the affected area. EA can also present in the lower right quadrant. Other less common symptoms are:
Epiploic appendagitis has symptoms that mimic other conditions that can cause severe lower abdominal pain—such asappendicitis,diverticulitis, orcholecystitis(gallbladder inflammation)—it can be tricky to diagnose. Also, because this condition is rare and only accounts for about 1.3% of abdominal pain visits to emergency departments, EA is commonly overlooked or misdiagnosed.
Risk Factors: Who Gets Epiploic Appendagitis?
Almost anyone can get epiploic appendagitis. Occurrence rates are slightly higher in male vs. female patients seen for abdominal pain at hospital emergency rooms. Having obesity and performing intense exercise can increase a person’s odds of getting EA, but there aren’t any other well-established risk factors.
Although it typically occurs in adults up to age 50, it’s not unheard-of for children as young as 8 years old to get epiploic appendagitis.The average age for someone to get EA is 44.6 years old.
How Is Epiploic Appendagitis Diagnosed?
Epiploic appendagitis is best diagnosed using a computed tomography (CT) scan. If epiploic appendagitis is present, it shows a characteristic EA lesion in the left or right lower abdominal quadrant.Sonography(ultrasound) is also used for diagnosis.
Getting an accurate epiploic appendagitis diagnosis and differentiating it from other, more serious causes of abdominal pain that typically require surgery is important. Early diagnosis can improve treatment.
Epiploic Appendagitis Treatment Options
Most people diagnosed with primary epiploic appendagitis are treated extremely conservatively, without surgery or antibiotics since it often goes away on its own.
Although OTC NSAIDs such as Advil and Motrin (ibuprofen) or Aleve (naproxen) are the gold standard treatment option, many people with EA often get better in less than 10 days with or without taking anti-inflammatory drugs.
Although epiploic appendagitis is typically benign (harmless) and doesn’t have complications, a single case has been reported in which an individual with EA developed severesepsisand acuterespiratory distress.After the identification and removal of a single EA, the patient recovered quickly.
In general, epiploic appendagitis has a favorable prognosis. Individuals with this condition typically get better in about five to seven days and don’t experience any long-term effects. Recurrence is rare.
What’s the Long-Term Outlook With Epiploic Appendagitis?
The outlook for someone with epiploic appendagitis is typically very good. EA is self-limiting and usually resolves in fewer than 10 days without the need for surgery or hospitalization. Of all the things that can cause lower abdominal pain severe enough to prompt a visit to the emergency room, if properly diagnosed, epiploic appendagitis is one of the most benign.
Summary
Dozens of tiny pouches called epiploic appendages are attached to the outside of your colon. When one of these dangling appendages gets twisted, it causes inflammation and sharp abdominal pain. The medical term for this condition is epiploic appendagitis (EA).
EA usually isn’t serious. It tends to heal itself within about a week. The recommended treatment is typically OTC anti-inflammatory drugs. Early and accurate diagnosis via CT scan is key. If you have EA, the goal is to avoid unnecessary surgery and hospitalization.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Acevedo-Castillo CD, Macias-Cruz HM, Ramirez-Cisneros A, Bautista-Coronado UA, Moran-Guerrero JA, Guzman EA.Epiploic appendagitis: systematic review of a distinctive pathology.The American Surgeon.Published online May 17, 2024 doi:10.1177/00031348241256062Cho MS, Hwang-Bo S, Choi UY, Kim HS, Hahn SH.A case of epiploic appendagitis with acute gastroenteritis.Pediatr Gastroenterol Hepatol Nutr. 2014;17(4):263. doi:10.5223/pghn.2014.17.4.263Osmosis.Epiploic appendagitis: What causes it, diagnosis, and more. June 27, 2022.Giannis D, Matenoglou E, Sidiropoulou MS, et al.Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker.Ann Transl Med. 2019;7(24):814-814. doi:10.21037/atm.2019.12.74Yang L, Jia M, Han P.Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male: A case report.Medicine. 2019;98(33):e16846. doi:10.1097/MD.0000000000016846Abramov D, Daniel R, Pellegrini Jr. JR, Rivera AP.Bacteremia secondary to epiploic appendagitis (EA).Cureus. Published online July 10, 2023. doi:10.7759/cureus.41648Akubudike JTE, Egigba OF, Kobalava B.Epiploic appendagitis: a commonly overlooked differential of acute abdominal pain.Cureus. Published online January 20, 2021. doi:10.7759/cureus.12807Choi YI, Woo HS, Chung JW, et al.Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence.Intest Res. 2019;17(4):554-560. doi:10.5217/ir.2018.00148Christenson RV, Nguyen PD, Wallace LR.A case of recurrent epiploic appendagitis treated with conservative management.Cureus. Published online August 4, 2022. doi:10.7759/cureus.27686Bianchi F, Leganés Villanueva C, Brun Lozano N, Goruppi I, Boronat Guerrero S.Epiploic appendagitis and omental infarction as rare causes of acute abdominal pain in children.Pediatric Reports. 2021;13(1):76-85. doi:10.3390/pediatric13010010The Journal of Urgent Care Medicine (JUCM).Epiploic appendagitis. Published on May 1, 2015.Choi YU, Choi PW, Park YH, et al.Clinical characteristics of primary epiploic appendagitis.J Korean Soc Coloproctol. 2011;27(3):114. doi:10.3393/jksc.2011.27.3.114Choi YU, Choi PW, Park YH, et al.Clinical characteristics of primary epiploic appendagitis.J Korean Soc Coloproctol. 2011;27(3):114. doi:10.3393/jksc.2011.27.3.114Idrissi MB, Akammar A.Diagnosing and treating epiploic appendagitis: A review of two cases.Journal of Surgical Case Reports. 2023;2023(3):rjad156. doi:10.1093/jscr/rjad156Suzuki M, Watari T.Primary epiploic appendagitis: a rare cause of localised abdominal pain.BMJ Case Rep. 2024;17(2):e259403. doi:10.1136/bcr-2023-259403Leavitt NJ, Kazi US, Cromwell R, Modi F.Unique case of severe sepsis and acute respiratory failure in the setting of aseptic epiploic appendagitis of the descending colon.Korean J Gastroenterol. 2023;82(6):300-303. doi:10.4166/kjg.2023.111Lorente C, Hearne CB, Taboada J.Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis.Baylor University Medical Center Proceedings. 2017;30(1):44-46. doi:10.1080/08998280.2017.11929522Additional ReadingSand M, Gelos M, Bechara FG, et al.Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis.BMC Surg. 2007;7(1):11. doi:10.1186/1471-2482-7-11
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Acevedo-Castillo CD, Macias-Cruz HM, Ramirez-Cisneros A, Bautista-Coronado UA, Moran-Guerrero JA, Guzman EA.Epiploic appendagitis: systematic review of a distinctive pathology.The American Surgeon.Published online May 17, 2024 doi:10.1177/00031348241256062Cho MS, Hwang-Bo S, Choi UY, Kim HS, Hahn SH.A case of epiploic appendagitis with acute gastroenteritis.Pediatr Gastroenterol Hepatol Nutr. 2014;17(4):263. doi:10.5223/pghn.2014.17.4.263Osmosis.Epiploic appendagitis: What causes it, diagnosis, and more. June 27, 2022.Giannis D, Matenoglou E, Sidiropoulou MS, et al.Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker.Ann Transl Med. 2019;7(24):814-814. doi:10.21037/atm.2019.12.74Yang L, Jia M, Han P.Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male: A case report.Medicine. 2019;98(33):e16846. doi:10.1097/MD.0000000000016846Abramov D, Daniel R, Pellegrini Jr. JR, Rivera AP.Bacteremia secondary to epiploic appendagitis (EA).Cureus. Published online July 10, 2023. doi:10.7759/cureus.41648Akubudike JTE, Egigba OF, Kobalava B.Epiploic appendagitis: a commonly overlooked differential of acute abdominal pain.Cureus. Published online January 20, 2021. doi:10.7759/cureus.12807Choi YI, Woo HS, Chung JW, et al.Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence.Intest Res. 2019;17(4):554-560. doi:10.5217/ir.2018.00148Christenson RV, Nguyen PD, Wallace LR.A case of recurrent epiploic appendagitis treated with conservative management.Cureus. Published online August 4, 2022. doi:10.7759/cureus.27686Bianchi F, Leganés Villanueva C, Brun Lozano N, Goruppi I, Boronat Guerrero S.Epiploic appendagitis and omental infarction as rare causes of acute abdominal pain in children.Pediatric Reports. 2021;13(1):76-85. doi:10.3390/pediatric13010010The Journal of Urgent Care Medicine (JUCM).Epiploic appendagitis. Published on May 1, 2015.Choi YU, Choi PW, Park YH, et al.Clinical characteristics of primary epiploic appendagitis.J Korean Soc Coloproctol. 2011;27(3):114. doi:10.3393/jksc.2011.27.3.114Choi YU, Choi PW, Park YH, et al.Clinical characteristics of primary epiploic appendagitis.J Korean Soc Coloproctol. 2011;27(3):114. doi:10.3393/jksc.2011.27.3.114Idrissi MB, Akammar A.Diagnosing and treating epiploic appendagitis: A review of two cases.Journal of Surgical Case Reports. 2023;2023(3):rjad156. doi:10.1093/jscr/rjad156Suzuki M, Watari T.Primary epiploic appendagitis: a rare cause of localised abdominal pain.BMJ Case Rep. 2024;17(2):e259403. doi:10.1136/bcr-2023-259403Leavitt NJ, Kazi US, Cromwell R, Modi F.Unique case of severe sepsis and acute respiratory failure in the setting of aseptic epiploic appendagitis of the descending colon.Korean J Gastroenterol. 2023;82(6):300-303. doi:10.4166/kjg.2023.111Lorente C, Hearne CB, Taboada J.Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis.Baylor University Medical Center Proceedings. 2017;30(1):44-46. doi:10.1080/08998280.2017.11929522Additional ReadingSand M, Gelos M, Bechara FG, et al.Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis.BMC Surg. 2007;7(1):11. doi:10.1186/1471-2482-7-11
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Acevedo-Castillo CD, Macias-Cruz HM, Ramirez-Cisneros A, Bautista-Coronado UA, Moran-Guerrero JA, Guzman EA.Epiploic appendagitis: systematic review of a distinctive pathology.The American Surgeon.Published online May 17, 2024 doi:10.1177/00031348241256062Cho MS, Hwang-Bo S, Choi UY, Kim HS, Hahn SH.A case of epiploic appendagitis with acute gastroenteritis.Pediatr Gastroenterol Hepatol Nutr. 2014;17(4):263. doi:10.5223/pghn.2014.17.4.263Osmosis.Epiploic appendagitis: What causes it, diagnosis, and more. June 27, 2022.Giannis D, Matenoglou E, Sidiropoulou MS, et al.Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker.Ann Transl Med. 2019;7(24):814-814. doi:10.21037/atm.2019.12.74Yang L, Jia M, Han P.Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male: A case report.Medicine. 2019;98(33):e16846. doi:10.1097/MD.0000000000016846Abramov D, Daniel R, Pellegrini Jr. JR, Rivera AP.Bacteremia secondary to epiploic appendagitis (EA).Cureus. Published online July 10, 2023. doi:10.7759/cureus.41648Akubudike JTE, Egigba OF, Kobalava B.Epiploic appendagitis: a commonly overlooked differential of acute abdominal pain.Cureus. Published online January 20, 2021. doi:10.7759/cureus.12807Choi YI, Woo HS, Chung JW, et al.Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence.Intest Res. 2019;17(4):554-560. doi:10.5217/ir.2018.00148Christenson RV, Nguyen PD, Wallace LR.A case of recurrent epiploic appendagitis treated with conservative management.Cureus. Published online August 4, 2022. doi:10.7759/cureus.27686Bianchi F, Leganés Villanueva C, Brun Lozano N, Goruppi I, Boronat Guerrero S.Epiploic appendagitis and omental infarction as rare causes of acute abdominal pain in children.Pediatric Reports. 2021;13(1):76-85. doi:10.3390/pediatric13010010The Journal of Urgent Care Medicine (JUCM).Epiploic appendagitis. Published on May 1, 2015.Choi YU, Choi PW, Park YH, et al.Clinical characteristics of primary epiploic appendagitis.J Korean Soc Coloproctol. 2011;27(3):114. doi:10.3393/jksc.2011.27.3.114Choi YU, Choi PW, Park YH, et al.Clinical characteristics of primary epiploic appendagitis.J Korean Soc Coloproctol. 2011;27(3):114. doi:10.3393/jksc.2011.27.3.114Idrissi MB, Akammar A.Diagnosing and treating epiploic appendagitis: A review of two cases.Journal of Surgical Case Reports. 2023;2023(3):rjad156. doi:10.1093/jscr/rjad156Suzuki M, Watari T.Primary epiploic appendagitis: a rare cause of localised abdominal pain.BMJ Case Rep. 2024;17(2):e259403. doi:10.1136/bcr-2023-259403Leavitt NJ, Kazi US, Cromwell R, Modi F.Unique case of severe sepsis and acute respiratory failure in the setting of aseptic epiploic appendagitis of the descending colon.Korean J Gastroenterol. 2023;82(6):300-303. doi:10.4166/kjg.2023.111Lorente C, Hearne CB, Taboada J.Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis.Baylor University Medical Center Proceedings. 2017;30(1):44-46. doi:10.1080/08998280.2017.11929522
Acevedo-Castillo CD, Macias-Cruz HM, Ramirez-Cisneros A, Bautista-Coronado UA, Moran-Guerrero JA, Guzman EA.Epiploic appendagitis: systematic review of a distinctive pathology.The American Surgeon.Published online May 17, 2024 doi:10.1177/00031348241256062
Cho MS, Hwang-Bo S, Choi UY, Kim HS, Hahn SH.A case of epiploic appendagitis with acute gastroenteritis.Pediatr Gastroenterol Hepatol Nutr. 2014;17(4):263. doi:10.5223/pghn.2014.17.4.263
Osmosis.Epiploic appendagitis: What causes it, diagnosis, and more. June 27, 2022.
Giannis D, Matenoglou E, Sidiropoulou MS, et al.Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker.Ann Transl Med. 2019;7(24):814-814. doi:10.21037/atm.2019.12.74
Yang L, Jia M, Han P.Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male: A case report.Medicine. 2019;98(33):e16846. doi:10.1097/MD.0000000000016846
Abramov D, Daniel R, Pellegrini Jr. JR, Rivera AP.Bacteremia secondary to epiploic appendagitis (EA).Cureus. Published online July 10, 2023. doi:10.7759/cureus.41648
Akubudike JTE, Egigba OF, Kobalava B.Epiploic appendagitis: a commonly overlooked differential of acute abdominal pain.Cureus. Published online January 20, 2021. doi:10.7759/cureus.12807
Choi YI, Woo HS, Chung JW, et al.Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence.Intest Res. 2019;17(4):554-560. doi:10.5217/ir.2018.00148
Christenson RV, Nguyen PD, Wallace LR.A case of recurrent epiploic appendagitis treated with conservative management.Cureus. Published online August 4, 2022. doi:10.7759/cureus.27686
Bianchi F, Leganés Villanueva C, Brun Lozano N, Goruppi I, Boronat Guerrero S.Epiploic appendagitis and omental infarction as rare causes of acute abdominal pain in children.Pediatric Reports. 2021;13(1):76-85. doi:10.3390/pediatric13010010
The Journal of Urgent Care Medicine (JUCM).Epiploic appendagitis. Published on May 1, 2015.
Choi YU, Choi PW, Park YH, et al.Clinical characteristics of primary epiploic appendagitis.J Korean Soc Coloproctol. 2011;27(3):114. doi:10.3393/jksc.2011.27.3.114
Idrissi MB, Akammar A.Diagnosing and treating epiploic appendagitis: A review of two cases.Journal of Surgical Case Reports. 2023;2023(3):rjad156. doi:10.1093/jscr/rjad156
Suzuki M, Watari T.Primary epiploic appendagitis: a rare cause of localised abdominal pain.BMJ Case Rep. 2024;17(2):e259403. doi:10.1136/bcr-2023-259403
Leavitt NJ, Kazi US, Cromwell R, Modi F.Unique case of severe sepsis and acute respiratory failure in the setting of aseptic epiploic appendagitis of the descending colon.Korean J Gastroenterol. 2023;82(6):300-303. doi:10.4166/kjg.2023.111
Lorente C, Hearne CB, Taboada J.Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis.Baylor University Medical Center Proceedings. 2017;30(1):44-46. doi:10.1080/08998280.2017.11929522
Sand M, Gelos M, Bechara FG, et al.Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis.BMC Surg. 2007;7(1):11. doi:10.1186/1471-2482-7-11
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