Diagnosis and management of epiploic appendagitis: a single-institution 10-year experience

Introduction: Epiploic appendagitis is known to be a benign and self-limiting process, yet optimal management is not well understood. Research focused on the efficacy of treatment in this rare condition may allow future patients diagnosed with epiploic appendagitis to be treated accordingly with the best evidence-based medical practice. Aim: The aim of this study was to investigate the diagnosis, compare management options and follow up epiploic appendagitis. Materials and methods: This retrospective study included all patients over 18 years of age who were treated in a large tertiary hospital in the years 2009-2019 with a confirmed diagnosis of epiploic appendagitis and no coexisting acute intra-abdominal pathologies. Patients' health information was recorded and analysed. Results: As many as 78 patients were diagnosed with epiploic appendagitis over a 10-year observation period. A minor male predominance (55%) and a broad range of ages at the moment of diagnosis (18-75) were found, with diabetes (n = 10) being the most common comorbidity in this condition. In the majority of cases, the disease was located in the sigmoid (41%) and descending colon (35%). Diagnosis was primarily based on imaging (computerised tomography 91%, ultrasonography 2.6%). Six percent of patients were diagnosed during surgery and these patients recovered with smaller rates of readmissions and recurrences (P < 0.05). Patients given opioids on discharge were less likely to be readmitted to hospital (P < 0.05), while those given antibiotics had a longer inpatient stay (P < 0.05) with no change in readmission rates (P = 0.78) or recurrence rates (P = 0.48). Discussion: Managing epiploic appendagitis with antibiotics is shown to have no effect on patient outcomes, while opioid use for pain control did not affect the length of hospital stay but it reduced the number of readmissions when compared to simple analgesics alone.