Unestimated disease: epiploic appendagitis

Epiploic appendagitis (EA) is an unusual cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal disorders. It is most frequently confused with acute appendicitis and diverticulitis. EA is very infrequently diagnosed, in part due to a low or absent awareness of this condition among general surgeons. We aim to draw attention to EA by presenting 13 cases of this relatively rare disorder with differential diagnoses of acute abdominal disease. A diagnosis of EA should be considered in patients with sharp, localised, acute abdominal pain unassociated with any other symptoms (such as vomiting, nausea, or fever) or unusual laboratory test results. Although infrequently diagnosed to date, EA may become more frequently detected in the future with the increasing use of abdominal computed tomography (CT) and ultrasound. Surgeons should be aware of this self-limiting disease because it mimics many other acute intra-abdominal diseases. When non-invasive techniques fail to diagnose EA, diagnostic laparoscopy or even laparotomy should be employed to rule out other acute abdominal disorders.