Have you ever had a sudden, sharp pain in your abdomen? It's like you could point it with your finger. We often get scared at times like this, don't we? One reason for this is a condition that is not very well known, but it's worth knowing about. This is called Epiploic Appendagitis. Although the name may sound a bit strange, let's explain it simply.
So what is Epiploic Appendagitis?
Simply put, Epiploic Appendagitis is a sudden onset of pain in your abdomen. The name means " inflammation of an epiploic appendix." Okay, now you're wondering what these "epiploic appendages" are. They are the little fatty appendages that hang off the outside of our colon. Think of them as little grapes hanging off a vine.
So, what happens if this little piece of fat (the epiploic appendage) suddenly twists (torsion)? Then the blood supply to it is cut off. Imagine a water pipe that is twisted very tightly in one place. Then the water will not flow through it, right? That's what happens when this fatty part is twisted. When the blood supply is cut off, that part becomes inflamed, which means it swells, becomes red, and causes pain. That's the pain you feel in your stomach.
Most of the time, this pain comes on very suddenly. You can tell exactly where it hurts. But because this condition is so uncommon, even doctors can sometimes confuse it with other conditions that cause more common abdominal pain. For example:
- Appendicitis - This means inflammation of the appendix.
- Cholecystitis - This means inflammation of the gallbladder.
- Diverticulitis - This is inflammation of the small pouches in the wall of the large intestine.
How common is Epiploic Appendigitis?
It's hard to say exactly how common this is, because it can often go undiagnosed. Researchers estimate that about 1% of people hospitalized for sudden abdominal pain may have this condition. Also, about 5% of people diagnosed with diverticulitis or appendicitis actually have what's called epiploic appendagitis. That means that sometimes, while we might think it's something serious, the cause could be something as simple as this.
Is Epiploic Appendagitis a serious condition?
Here's the important thing. Epiploic appendagitis is not usually a serious condition. However, as mentioned earlier, the problem is that it can be confused with other serious conditions. Compared to other conditions, this condition often resolves without any specific treatment. The inflamed fatty piece (epiploic appendage) dries out over time, calcifies, and eventually falls out of the large intestine. Then both the swelling and pain go away.
So remember, this is nothing to be alarmed about. However, if you experience stomach pain, it is essential to seek medical advice.
What causes this?
There are two main types of causes of Epiploic Appendigitis: Primary causes and secondary causes.
Primary causes
These are things that start right inside that fatty piece (appendage).
- Torsion: Most of the time (about 75%) this condition is caused by the twisting of the said piece of fat. Due to this twisting, the blood supply to it is almost completely cut off, and the tissues die due to the loss of blood supply . This is called (Infarction) in medical science.
- Thrombosis: Very rarely, a blood clot can form in a vein in these fatty deposits, blocking blood flow .
Secondary causes
These are the least common. What happens is that this piece of fat is affected by a problem elsewhere.
- An infection spreading from another location: For example, if there is an infection elsewhere in the abdomen, it can spread to this fatty lump.
- Swelling of the surrounding tissue causing the fat lump to bulge: Sometimes, when the surrounding tissue swells, it can cause the fat lump to bulge and cause problems.
Who is most at risk for this?
Some research has shown that certain people are more likely to develop Epiploic Appendigitis. Let's see who they are.
- People with obesity : This may be because these fat cells can also become larger in people with excess body fat .
- People with hernias: A hernia is a protrusion of an internal organ or tissue through a weak spot in the body cavity.
- People with diverticulosis (small pouches in the large intestine): The risk is also higher in this condition.
- People who exercise intensely: Sometimes, things like this can happen even when you exercise harder than you think.
- Middle-aged people (between 40-50 years old): People in this age group see a little more.
- Male: It is said to be more common among men than women.
But not everyone develops this just because they have these risk factors , and it can also develop in someone who has none of these.
What are the symptoms of this?
The main symptom is pain in one part of the stomach. This can start suddenly and last for several weeks. The epiploic appendages are located in the lower part of our colon. Therefore, this pain is most often felt in the lower part of the stomach. Three out of four people say that they have pain in the lower part of the stomach. And more than half say that it is on the left side.
This pain is described as follows:
- Sharp: Like stabbing with a knife.
- Constant: Continuous, with or without change.
- Intense: So intense that it's hard to bear.
Also, the pain may increase during times like these:
- When coughing
- When stretching the body
- When breathing loudly
In addition to this pain, several other symptoms may be seen:
- Guarding: Imagine if someone tried to touch your stomach, you would automatically tighten your grip on the area, as if covering it with your hand. That's what we call 'guarding'.
- Rebound tenderness: When the doctor presses on your abdomen and then suddenly removes his hand, the pain seems to increase more than before.
- A palpable mass: Sometimes the inflamed fatty lump (appendage) can become so swollen that it feels like a lump when touched from the outside.
These symptoms are similar to the symptoms of the previously mentioned diseases such as appendicitis, cholecystitis, and diverticulitis. However, in those diseases, there are often additional symptoms such as fever, nausea , and vomiting . So, if you have a sharp pain in one place in the abdomen like this, but do not have those additional symptoms (such as fever and vomiting), the doctor may suspect Epiploic Appendagitis.
How do you diagnose this?
A radiologist can diagnose epiploic appendagitis using an ultrasound scan or a CT scan (computed tomography scan). A healthy epiploic appendage is usually not visible on these scans. However, an inflamed one can be clearly seen. This is because the inflammation causes it to fill with fluid and appear bright on the scan. It appears as an oval-shaped mass right where the pain is.
What is the best treatment for this?
Doctors usually start by giving nonsteroidal anti-inflammatory drugs (NSAIDs) . These reduce swelling and pain. For example, ibuprofen. If necessary, other painkillers can be given in addition. Most people get relief quickly with these drugs. If this does not help, in rare cases, surgery may be needed to remove the inflamed appendix.
How long does it usually take for Epiploic Appendigitis to heal?
Even without treatment, symptoms of Epiploic Appendagitis rarely last more than a week. In some cases, they can last up to four weeks. However, with medication, the symptoms usually resolve within a few days. So, there is nothing to worry about.
When is surgery necessary?
Surgery for epiploic appendagitis is very, very rare. However, if your symptoms do not improve at all, or if there is still doubt about your diagnosis, your doctor may need to look inside your abdomen to find the real cause of your persistent pain.
They use a minimally invasive surgical procedure called laparoscopy to do this. In this procedure, the surgeon makes three or four small (about half an inch) incisions in your abdomen and inserts a small camera called a laparoscope through them. The surgeon uses a video camera to view the images on a screen and then passes long, thin instruments through the small incisions to remove the inflamed appendix.
What is your final word on this situation?
Epiploic appendagitis can be painful and scary. But generally speaking, it's nothing to worry about. Unlike your appendix, gallbladder, or diverticula, an epiploic appendage is not at risk of rupture due to inflammation. Usually, the inflammation gradually subsides, the fatty lump dies, and everything is over within a week.
Is there a link between Epiploic Appendigitis and Cancer?
There is no known link between Epiploic Appendagitis and cancer, so don't worry about it.
Are there any foods to eat or avoid to prevent this?
There is no known connection between Epiploic Appendagitis and your eating habits. Therefore, there are no specific foods to eat or avoid.
So, if you ever have Epiploic Appendigitis, it will probably be the first and last time you hear about it. You may be scared by the sudden pain, and you may end up going to the emergency room, thinking that something serious is going to happen. But the treatment for Epiploic Appendigitis is very simple, and surgery is rarely needed. You may come home with a strange story to tell everyone else who has never heard of it.
The most important things for you to remember (Take-Home Message)
- Epiploic appendagitis is a sudden abdominal pain caused by a small piece of fatty tissue hanging from the outside of the large intestine (colon) twisting, losing its blood supply, and becoming inflamed.
- Although this can often be confused with other conditions such as appendicitis , symptoms such as fever and vomiting are usually less severe.
- This is not a serious condition, and most of the time it heals on its own within a week or two.
- Treatment is mainly with painkillers and nonsteroidal anti-inflammatory drugs (NSAIDs). Surgery is rarely required.
- However, if you experience sudden, severe stomach pain, you should definitely seek medical advice, as it could be a symptom of another serious condition.
So I hope you have a good understanding of Epiploic Appendagitis. Stay healthy!
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