Epiploic appendagitis is a rare condition that causes intense stomach pain and inflammation. It’s often mistaken for other conditions, like diverticulitis or appendicitis. It’s caused by a loss of blood flow to one of your epiploic appendages, which are small fat-filled sacs that line the outside of the colon and large intestine.

Unlike the conditions that it’s often confused with, epiploic appendagitis usually doesn’t require surgical treatment and can often resolve on its own.

Epiploic appendagitis occurs when you lose blood flow to very small pouches of fat situated along the surface of the colon or large intestine.

These pouches are called epiploic appendages. People typically have between 50 and 100 of them over their large intestine.

Normally, this fatty tissue gets its blood supply from small vessels attached to the outside of the colon. But, because these pouches of tissue are thin and narrow, their blood supply can become easily cut off. When this happens, the tissue becomes inflamed and causes severe pain in the lower abdomen.

There are two categories of epiploic appendagitis: primary epiploic appendagitis and secondary epiploic appendagitis. While they both involve a loss of blood flow to your epiploic appendages, they have different causes.

Primary epiploic appendagitis

Primary epiploic appendagitis occurs when the blood supply to your epiploic appendages gets cut off. Sometimes an appendage gets twisted, which pinches blood vessels and stops blood flow. In other cases, the blood vessels can suddenly collapse or get a blood clot. This also blocks the flow of blood.

Secondary epiploic appendagitis

A case of secondary epiploic appendagitis is caused by another condition that limits blood flow to these appendages. This can happen when the tissue around the colon, or the colon itself, becomes infected or inflamed, like in diverticulitis or appendicitis.

Any inflammation and swelling that changes the blood flow in and around the colon can change the blood flow to the appendages.

The main symptom of epiploic appendagitis is lower abdominal pain.

This pain often occurs on the lower right or left abdomen, but it does not shift to other parts of the abdomen. Pain that moves to a new location, especially when it begins on the lower left abdomen, may be a sign of a different illness that requires immediate medical attention.

Your pain can be accompanied by inflammation and tenderness. Rarely, the enflamed appendage can feel like a mass to the touch, depending on the location of the inflamed appendage.

You may also notice the pain come and go. If you press on the area that hurts, you might feel some tenderness when you remove your hand. The pain can worsen when you stretch, cough, or take a deep breath.

Unlike other abdominal conditions, the pain typically stays in the same place once it starts. Blood tests tend to be normal. The following symptoms may be possible but are rare:

  • nausea or vomiting
  • low-grade fever
  • loss of appetite
  • diarrhea
  • bloating
  • feelings of fullness

If you experience intense abdomen pain or abdomen pain along with any of these symptoms, it’s best to have someone take you to urgent care or the emergency room. Your symptoms may be a sign of a serious condition.

Learn more about other causes of pain in your lower left abdomen.

Few things increase your risk of developing epiploic appendagitis. But it seems to be more common in men around the age of 50. While uncommon, cases have been reported in children and older adults.

Other possible risk factors include:

  • Obesity. Obesity can increase the amount of fatty tissue and the number of appendages.
  • Large meals. Eating larger meals can alter the blood flow to the intestinal tract.
  • Strenuous exercise. Intensive, strenuous exercise may contribute to epiploic appendages twisting.

Diagnosing epiploic appendagitis usually involves ruling out other conditions with similar symptoms, like diverticulitis or appendicitis. A doctor will start by giving you a physical exam and asking about your symptoms and medical history.

During the physical exam, a doctor may feel your abdomen region to check for inflammation, pain, and tenderness.

They may also perform a blood test to check your white blood cell count. Epiploic appendagitis can sometimes cause a slightly elevated white blood cell count. But if it’s abnormally elevated, you’re more likely to have diverticulitis or another condition.

You may also have a fever if you have diverticulitis, which happens when pouches from your colon become inflamed or infected.

You may need a CT scan or ultrasound to help diagnose the condition. These imaging tests give your doctor a better view of your abdomen. It allows them to see what might be causing your symptoms.

Epiploic appendagitis looks different on a CT scan compared to other intestinal problems.

On a CT scan, epiploic appendagitis can show up as a fatty mass in the shape of an oval, usually about 1.5 to 3.5 centimeters in diameter. One 2019 review noted that some have been reported as being up to 10 centimeters long. Doctors may make a diagnosis after seeing inflammation centered over the epiploic appendage.

While less common, an MRI may be used to confirm the diagnosis.

Additional tests that a doctor may order to rule out other conditions include:

Epiploic appendagitis is usually considered to be a self-limiting disease. This means it goes away on its own without treatment.

In the meantime, your doctor may suggest taking over-the-counter pain relievers, like acetaminophen (Tylenol) or ibuprofen (Advil). You may need antibiotics in some cases. Your symptoms should start to get better within a week.

Surgery may be necessary in cases of significant complications or recurrent episodes.

There’s no specific diet that someone with epiploic appendagitis should or shouldn’t follow. But because obesity and eating large meals seem to be risk factors, maintaining a moderate weight may help prevent episodes.

Cases of secondary epiploic appendagitis usually clear up once the underlying condition is treated. Depending on the condition, you may need to have your appendix or gallbladder removed or receive other intestinal surgery.

The chances for complications for this condition are rare.

While uncommon, an affected appendage can become hardened or strangulated and break off. In this case, surgery may be necessary to remove the appendage. Sometimes, cases of epiploic appendagitis can recur and may need surgery.

While the pain of epiploic appendagitis can be intense, the condition usually resolves on its own within a week or two.

Keep in mind that this condition is relatively rare. If you have severe abdominal pain, it’s best to see your doctor so they can rule other possible and more common causes that may need surgical treatment, like appendicitis.