Epiploic appendagitis mimicking acute abdomen: geographic variation in anatomical distribution

Epiploic appendagitis (EA) is an uncommon, self-limited condition that often mimics acute abdomen. Misdiagnosis may lead to unnecessary imaging or surgical intervention. While geographic variation has been described in other colonic diseases, its role in the anatomical distribution of EA remains unclear. We conducted a retrospective analysis of adult patients with computed tomography (CT)-confirmed EA at a tertiary medical center and performed a systematic review of published case reports and series from 1974 to June 2023. Studies reporting the anatomical location of EA were included. They were classified as Asian or non-Asian according to the geographic region of the reporting institution. A total of 1,202 patients were analyzed, including 78 institutional cases and 1,124 cases from 165 publications. EA most commonly involved the left colon (68%). Significant geographic variation in segmental distribution was observed. In Asian populations, the descending colon was the predominant site (26% vs. 11%, p < 0.0001), whereas the sigmoid colon was more frequently involved in non-Asian populations (38% vs. 19%, p < 0.0001). On the right side, EA more commonly affected the ascending colon in Asians (14% vs. 9%, p = 0.024) and the cecum in non-Asians (12% vs. 5%, p < 0.0001). Our findings suggest geographic variation in the reported anatomical distribution of EA. Recognition of these patterns may assist clinicians in considering EA in the differential diagnosis of acute abdominal pain and may help avoid unnecessary imaging, antibiotic use, and surgical consultation. Registered on ClinicalTrials.gov (NCT06217978) on May 31, 2021.