Epiploic appendagitis is a rare condition that causes intense stomach pain. It’s often mistaken for other conditions, such as diverticulitis or appendicitis.

It happens when you lose blood flow to very small pouches of fat that are situated over the colon, or large intestine. This fatty tissue gets its blood supply from small vessels attached to the outside of the colon. Because these pouches of tissue are thin and narrow, their blood supply can become easily cut off. When this happens, the tissue becomes inflamed. These pouches are called epiploic appendages. People typically have between 50 and 100 of them over their large intestine.

Unlike the conditions it’s often confused with, epiploic appendagitis usually doesn’t require surgical treatment.

The main symptom of epiploic appendagitis is abdominal pain. The epiploic appendages on the left side of your colon tend to be larger and more vulnerable to becoming twisted or irritated. As a result, you’re more likely to feel pain in your lower left abdomen. Learn more about other causes of pain in your lower left abdomen.

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 often gets worse 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. It’s also rare to have:

  • nausea
  • fever
  • vomiting
  • loss of appetite
  • diarrhea

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 the flow of blood. In other cases, the blood vessels can suddenly collapse or get a blood clot. This blocks the flow of blood to the appendage.

Secondary epiploic appendagitis

Secondary epiploic appendagitis occurs 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.

Few things increase your risk of developing epiploic appendagitis. However, it seems to be more common in men between the ages of 40 and 50.

Other possible risk factors include:

  • Obesity. Obesity can increase the number of appendages.
  • Large meals. Eating larger meals can alter the blood flow to the intestinal tract.

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

They may also perform a blood test to look at your white blood cell count. 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 also need a CT scan. This imaging test gives 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.

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, such as 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. However, because obesity and eating large meals seem to be risk factors, eating a balanced diet with portion control to maintain a healthy 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 other intestinal surgery.

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

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, such as appendicitis.