Epiploic Appendagitis: Systematic Review of a Distinctive Pathology

• Published in: The American surgeon Vol. 90; no. 11; p. 3074
• Main Authors: Acevedo-Castillo, Carlos D, Macias-Cruz, Hannia M, Ramirez-Cisneros, Arantxa, Bautista-Coronado, Uriel A, Moran-Guerrero, Jose A, Guzman, Eduardo Alberto
• Format: Journal Article
• Language: English
• Published: United States 01.11.2024
• Subjects: Abdomen, Acute - diagnosis; Abdomen, Acute - etiology; Abdominal Pain - diagnosis; Abdominal Pain - etiology; Adult; Appendicitis - complications; Appendicitis - diagnosis; Appendicitis - surgery; Colitis - complications; Colitis - diagnosis; Diagnosis, Differential; Diverticulitis - complications; Diverticulitis - diagnosis; Female; Humans; Male; epiploic appendices; epiploic appendagitis; acute abdominal pain
• ISSN: 1555-9823
• DOI: 10.1177/00031348241256062

Epiploic appendagitis (EA) is an essential cause of abdominal pain that can be confused with more typical causes such as acute diverticulitis and appendicitis. Epiploic appendagitis accounts for 1% of all cases of abdominal pain in adults. The scarcity of information has limited its recognition as an essential nonsurgical cause of acute abdominal pain. We performed a systematic review of all EA cases published. We searched Scopus, Medline, Web of Science, and Google Scholar to retrieve all available studies from January 2000 to November 2023. 196 case reports and case series were analyzed, with 371 patients with EA included. The mean age at the time of diagnosis was 39 years. Most patients were male (59%). The primary presenting symptoms were pain (100%), tenderness (59.5%), and rebound tenderness (27.4%). The left abdomen was the most common localization of pain (53%). The most frequently identified differential diagnoses were acute appendicitis (26.4%) and acute diverticulitis (16.1%). Most patients (53%) were treated conservatively, and 98 (26.4%) underwent surgical treatment. A significant difference in the choice of treatment was found for signs and symptoms such as rebound tenderness, nausea, anorexia, and diarrhea. Acute EA is an essential clinical condition of rare occurrence that might present a diagnostic challenge, as it can masquerade as another acute abdominal pain etiology. The optimal management of EA is conservative, so a higher recognition by surgeons and emergency physicians is essential to avoid unnecessary surgical interventions and their associated consequences.