Epiploic appendagitis is an inflammation of the fat-filled pouches present over the large intestine or the colon.
Anatomy of the Digestive System
The human digestive system is 30 feet in length in an adult. This whole digestive starts from the mouth and ends at the anus. There are eight main organs in the digestive tract systems that are of importance:
- Small Intestine
- Large Intestine (caecum, colon, rectum, anal canal, anus)
- Gall bladder
This blog is focused on the large intestine, specifically the colon, and the peritoneal pouches present on it.
The epiploic appendages are present in the large intestine. These are peritoneal structures. These structures arise from the serosal surface towards the peritoneal pouch. They are filled with adipose tissue and have their vascular stalk.
A normal person has about 50-100 epiploic appendages on the colon. They are specifically present on the transverse and sigmoid colon. The appendages enclose the veins and arteries that are responsible for the blood supply to the appendages. Lymphatic channels are either looped through the appendages or terminate in the appendage. The thickness of the epiploic appendage is 1 to 2 cm and 2 to 5 cm long.
The role of these appendages is unclear, but it is believed that they might provide protection and cushion effect to the colon. The appendage is most prominent in obese patients and people who are recovering from weight loss.
This particular condition refers to the inflammation of epiploic appendages. The inflammation occurs when the blood supply to the appendages gets cuts off. The blood supply is provided to the appendage through a small, thin vascular stalk. The vascular blood vessel is thin; the cutoff of blood supply becomes easier. This blood cutoff causes inflammation. There are two types of this condition:
Primary Epiploic Appendagitis
In this condition, two things can happen; the appendages might twist together, and the blood supply gets off, or a clot can form in the appendages that might cause the cutoff of the supply and hence cause inflammation.
Secondary Epiploic Appendagitis
In this type of epiploic appendagitis, the formation is secondary to the formation of appendicitis and colitis. The inflammation of the other organs interrupts the blood flow to the pouches, and thus inflammation occurs.
The epidemiology of epiploic appendagitis is not known as the diagnose is difficult. On average, about 2 to 7% of times, it has been misdiagnosed for diverticulitis, and in 0.3 to 1% cases misdiagnosed for appendicitis. There are many misdiagnosed cases. If proper care is not taken, this can cause the patient to hospitalize. Also, the most common age for the development of disease is 40 years old. The incidence is higher in men.
The risk factors of epiploic appendagitis are:
Obesity is linked with the increase of fat tissues in the body. As the epiploic appendages are made up of adipose tissue, obesity can increase the number of appendages.
- Large meals
Large meals can also be responsible for the cutoff of blood supply to the appendages.
- Ages between 40-50
Symptoms of Epiploic Appendagitis
The most common symptom of epiploic appendagitis is abdominal pain. Due to this symptom, this condition gets confused with diverticulitis (inflammation of diverticula) or appendicitis (inflammation of the appendix). The pain is more prominent in the lower abdomen. This is because the appendages on the left side are larger than those on the right side. Other symptoms include:
- Pain in the lower abdomen
- Low-grade fever
- Nausea due to pain
- Loss of appetite
Diagnosis of the Epiploic Appendagitis
If you have a fever with an unknown cause, the doctor will prescribe you a series of blood tests to show you white blood cell count. If the count is increased, it will be assumed that you have an infection. Then it will be a case of ruling out other inflammations such as diverticulitis, colitis, and appendicitis. This will be difficult as all the symptoms are similar.
Another most precise way to know about the presence of epiploic appendagitis is to do a CT Scan.
Normal CT scan does not show the presence of Epiploic appendages.
In the case of epiploic appendagitis, the CT Scan will show the appendage as an oval-shaped fatty lesion, and a ring will surround it.
Treatment of Epiploic Appendagitis
The treatment might include over-the-counter pain relief medicine and antibiotics if deemed necessary by the physician. The disease resolve on its own in most cases. Doctors only recommend pain relievers for the abdominal pain that might worsen before getting better.
Antibiotics are prescribed if the inflammation does not go on its own. These antibiotics will help lessen the inflammation readily.
Surgery is not necessary if it’s the primary epiploic appendagitis. In secondary surgery, surgery might be recommended to remove the inflamed appendix or other inflamed organs responsible for the inflammation of epiploic appendages.
There is no specific diet that can be followed for the treatment and precaution for this disease. Obesity is a risk factor so that healthy eating might be good for the patient with epiploic appendagitis. A proportional meal will be good for the patients.
As discussed above, this disease can get confused with diverticulitis, colitis, appendicitis, and lower abdominal inflammation, as the condition is rare. So, you should approach a doctor when feeling pain in the lower abdomen, fever, nausea, or vomiting. Try to eat healthy proportional meals so that you can avoid the disease. The positive outlook is that there will be no need for surgery in case of epiploic appendagitis. One can recover from the disease in about one week if proper care is taken.