Discussion: Epiploic appendages are fat pads, typically 1-2 cm long and 0.5-1.5 cm wide, that are attached along the serosal surface of the large bowel. These appendages usually number up to 100, and typically 25% of the total are located in the region of the cecum. Epiploic appendagitis is the result of appendage infarction, which occurs by way of vascular compromise. The mechanism of injury is usually either torsion or venous thrombosis. Patients with epiploic appendagitis commonly present with significant pain and tenderness in the absence of fever or leukocytosis. Approximately 1-4 % of patients initially thought to be suffering from diverticulitis or appendicitis are ultimately diagnosed with epiploic appendagitis. The diagnosis may be made by abdominal CAT scan with a high degree of accuracy. The pathognomonic radiographic finding is an ovoid, fat density lesion involving the colonic wall, with evidence of inflammatory change. Treatment is conservative, with bowel rest and pain relief. Non-steroidal anti-inflammatory agents are the preferred analgesic therapy, and symptoms typically resolve over a period of 1-4 weeks.
Conclusions: Specialists in Hospital Medicine should be aware of epiploic appendagitis as a rare clinical entity that usually presents in a fashion similar to appendicitis or diverticulitis. Careful examination of the abdominal CAT is the key to diagnosis, and may spare the patient unnecessary antibiotic therapy and unneeded surgical evaluation.