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Epiploic Appendagitis: Causes & Treatment

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson goes over a very odd and rare condition known as epiploic appendagitis. You'll learn what it is, what causes it and how it's usually treated.

Epiploic Appendages

If you could look inside your abdomen right now, and look in the direction of your colon, you'd see something interesting. You'd see 50-100, 0.5-5 cm long, 1-2 cm thick fatty things dangling from the external surface of your colon via a vascular stalk. In other words, via a stem-like structure that contains blood vessels.

These bits of tissue are called epiploic appendages or appendices epiploicae. These are basically dangling bits of fat that are involved in epiploic appendagitis. This lesson will outline the causes and treatments for this condition.

Epiploic appendages are seen along the colon here towards your right.
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What Is Epiploic Appendagitis?

Epiploic appendagitis is a term that refers to the inflammation (suffix: '-itis') and ischemic infarction of one or more such appendages. Ischemia is a term for an inadequate supply of oxygenated blood to all or part of a structure. Since cells need oxygenated blood to live, they die as a result of ischemia. This pathological cell death is called necrosis. An infarct then is an area of ischemic necrosis. In other words, it is an area of cell death as a result of ischemia.

Causes

What causes epiploic appendagitis? Well, each epiploic appendage encloses small blood vessels. And this is important to remember. If either of those vessels is obstructed in any way, oxygenated blood has a tough time reaching the appendage and so this leads to cell death and inflammation.

The two main reasons for this in epiploic appendagitis appear to be:

  • Torsion, the twisting of the appendage, which cuts off the blood flow. It's sort of like twisting a balloon. Nothing will get in or escape past the twist.
  • Spontaneous thrombosis of venous outflow. In other words, the deoxygenated blood can't be drained from the appendage as a result of a blood clot (thrombus). This creates congestion (a backup of blood). This congestion makes it hard for arterial (oxygenated blood) to get into the appendage.

Torsion is especially a possibility in obese individuals as their epiploic appendages can be over three times longer than in people with healthy weights. As you know, it's much easier to twist a longer piece of string than a shorter one, and the same idea goes for longer epiploic appendages.

Strenuous exercise has been linked to this condition as well.

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