Surgery for Epiploic Appendagitis

Michael J Jaronczyk, MD, Vladimir Daoud, MD, Ibrahim Daoud, MD. St. Francis Hospital & Medical Center

Introduction: Although epiploic appendagitis is normally treated conservatively, there is a select subset of patients who benefit from surgical intervention. Surgery may be required for diagnosis and/or treatment. We are presenting a small case series of patients who were managed surgically after failing non-operative observation.

Patient Data: Recently at our institution, two patients presented with persistent left lower quadrant pain. The first patient is a 55-year-old male who presented with left lower quadrant abdominal pain radiating to the left groin. The patient had tenderness on physical examination, but no other findings were elicited. The working diagnosis was an inguinal hernia, but one was not observed during the examination. He was scheduled for a diagnostic laparoscopy with a possible inguinal hernia repair. The second patient is a 50-year-old female who presented to the Emergency Department at an outside facility with an acute onset of left lower quadrant abdominal pain. A CT scan of the abdomen and pelvis was performed and a diagnosis of epiploic appendagitis was made. She was discharged with pain medication. However, the pain did not improve with medication. She sought a surgical opinion for definitive treatment. On physical examination, there was point tenderness in the left lower quadrant. This finding correlated with the cross-sectional images. She was scheduled for a diagnostic laparoscopy.

Treatment Course: During laparoscopic exploration, both patients had similar findings. There were inflammatory changes and adhesions in the left lower quadrant between the thickened, inflamed epiploica and the anterior abdominal wall. The pathology was at the location of maximal tenderness each patient exhibited on physical examination. Since the diagnosis was confirmed, the inflamed portions were resected with a LigaSure device. Post-operatively, both patients had immediate and complete cessation of their presenting symptoms. At their follow-up visits, the patients reported that they did not have a recurrence of the original symptoms. They had pain from surgery, which had resolved shortly after surgery. Neither patient had any surgical complications.

Conclusion: Epiploic appendagitis can be managed safely by surgical resection. As described by Sand et al, there are more common diseases with similar symptoms. Therefore, surgery may be a necessary diagnostic and therapeutic tool for this pathology. The increased use of CT scans may aid in diagnosing or ruling out this entity.