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Epiploic Appendagitis: Clinical Characteristics of an Underdiagnosed Condition

Zhihao Zhu, Dr. Christian Sommerhalder, Anthony V Nguyen, Lauren T Gallagher, Dr. Laila Rashidi

University of Texas Medical Branch


Background: Epiploic appendagitis (EA) is an understudied diagnosis, likely due to its self-limited course. As a result, many physicians are unaware of the pathology and are unsure of the proper treatment when faced with a case of EA. Radiologists are often more familiar with this pathology than emergency medicine, internal medicine, and surgical physicians. We set out to investigate risk factors associated with EA and whether it is currently being diagnosed and treated appropriately at our institution..

Methods: In this single center retrospective case series, we queried all adult and pediatric radiologic reports read for patients at our institution between 1/2008-10/2018 containing the keywords “Epiploic” or “Appendagitis”. Patient charts were reviewed for clinical course assessment. SAS was used for descriptive statistics.

Results: We identified 174 patients with EA: 83 acute cases without other probably causes for pain and 72 with incidental chronic EA. 52% (N=44) of patients were misdiagnosed or undiagnosed for their pain. 8% (N=7) patients were admitted unnecessarily, 24% (N=20) received antibiotics or other medical treatment, and two patients received operations for chronic cholecystitis/appendicitis with acute EA in the same location. 62% (N=52) were treated conservatively with pain medication only. Major risk factors noted were obesity (mean BMI=30.8±5.5) and diverticulosis (32% incidence, N=27). Mean age was 45.7(±16.7) years with a bimodal distribution.

Conclusion: Epiploic appendagitis continues to be undiagnosed or misdiagnosed at our institution,. We believe this may be the case nationally as well, resulting in unnecessary hospital admissions and prescriptions. Therefore, we describe an algorithm for appropriate diagnosis, as well as a descriptive statistics of the typical presentation, associated symptoms, and possible risk factors. To our knowledge this is the largest clinical case series of EA.

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