Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2025; 31(32): 109897
Published online Aug 28, 2025. doi: 10.3748/wjg.v31.i32.109897
Epiploic appendagitis: An overlooked cause of acute abdominal pain
Yasser El-Sawaf, Salman Alzayani, Nermin K Saeed, Adel S Bediwy, Reem Elbeltagi, Khaldoon Al-Roomi, Mohammed Al-Beltagi
Yasser El-Sawaf, Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
Yasser El-Sawaf, Department of Gastroenterology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Salman Alzayani, Khaldoon Al-Roomi, Department of Family and Community Medicine, College of Medicine and Health Sciences, Arabian Gulf University, Manama 26671, Bahrain
Nermin K Saeed, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, ‎Governmental Hospitals, Manama 26671, Bahrain
Nermin K Saeed, Medical Microbiology Section, Department of Pathology, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
Adel S Bediwy, Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
Adel S Bediwy, Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Reem Elbeltagi, Department of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
Mohammed Al-Beltagi, Department of Paediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Co-first authors: Yasser El-Sawaf and Salman Alzayani.
Author contributions: El-Sawaf Y contributed to the conception, design, literature review, and drafting of the manuscript; Alzayani S contributed equally as first co-author, participating in critical revision, clinical interpretation, and drafting of the differential diagnosis section; Saeed NK contributed to the microbiological and radiological aspects, imaging interpretation, and revision of the diagnostic sections; Bediwy AS contributed to the review of thoracoabdominal differentials and critically revised the manuscript; Elbeltagi R participated in data organization and formatting; Al-Roomi K contributed to the primary care perspective and manuscript revision; Al-Beltagi M supervised the entire project, critically revised the final manuscript, and serves as the corresponding author; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MD, PhD, Department of Pediatrics, Faculty of Medicine, Tanta University, 1 Hassan Radwan Street, Tanta 31511, Algharbia, Egypt. mbelrem@hotmail.com
Received: May 27, 2025
Revised: June 7, 2025
Accepted: August 1, 2025
Published online: August 28, 2025
Processing time: 94 Days and 15.8 Hours
Abstract
BACKGROUND

Epiploic appendagitis is a rare, often underrecognized cause of acute abdominal pain. Misdiagnosis can lead to unnecessary hospitalization, antibiotic use, or surgical intervention. Advances in imaging have improved the recognition of this self-limiting condition, but clinical awareness remains critical.

AIM

To provide a comprehensive update on the epidemiology, anatomy, pathogenesis, clinical presentation, diagnostic strategies, differential diagnosis, and management of epiploic appendagitis, emphasizing its distinguishing features from other causes of acute abdomen.

METHODS

A review of the literature was conducted, focusing on the clinical characteristics, imaging findings, differential diagnoses, and evidence-based management strategies for epiploic appendagitis.

RESULTS

Epiploic appendagitis typically presents with acute, localized, non-radiating abdominal pain without significant systemic symptoms. Diagnosis is heavily reliant on imaging, with computed tomography (CT) being the gold standard. Hallmark CT findings include a small, fat-density ovoid lesion adjacent to the colon, with the usual characteristic ring and dot signs. Differential diagnoses include mainly diverticulitis, appendicitis, omental infarction, and many other causes. Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation, reserving surgical intervention for rare, complicated cases.

CONCLUSION

Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions. Increased clinician awareness, coupled with judicious use of imaging, facilitates timely diagnosis and appropriate management, ensuring optimal patient outcomes.

Keywords: Epiploic appendagitis; Epiploic appendicitis; Appendices epiploicae inflammation; Abdominal fat necrosis; Acute abdominal pain; Divericulitis

Core Tip: Epiploic appendagitis should be considered in patients presenting with acute, localized lower abdominal pain without systemic symptoms. It often mimics diverticulitis or appendicitis but typically lacks fever, leukocytosis, or migratory pain. Computed tomography (CT) remains the gold standard for diagnosis, revealing a small, fat-density ovoid lesion adjacent to the colon with a hyperattenuating rim and, sometimes, a central dot sign. Management is conservative with nonsteroidal anti-inflammatory drugs and observation, as the condition is self-limiting. Awareness of persistent residual CT findings is essential to avoid confusion during future imaging. Improving clinician awareness can prevent unnecessary antibiotics, hospitalizations, and surgeries.