Gastro Case Challenge: Excruciating Abdominal Pain in a Woman Taking Benzodiazepines and Narcotics

Noah Gudel, DO; Lisa M. Rock, MD


December 07, 2022

Conservative management with anti-inflammatory medications and pain control are the mainstays of treatment for primary epiploic appendagitis.[1] The patient's symptoms usually regress within 1-2 weeks, although as noted, radiologic changes may persist.[1,12] Potential complications that have been reported include adhesions, local abscess formation, intussusception, intraperitoneal loose bodies, bowel obstruction, and peritonitis.[4,11]

Sand and colleagues[1] suggested that surgical intervention is preferable to expectant management, because four out of 10 patients in their study had multiple episodes before their initial presentation, and early surgery would (in theory) prevent complications, such as adhesions and abscess formation. They also noted that clinicians must consider the potential adverse effects associated with the multiple CT scans that are likely to be ordered for follow-up on these conservatively managed patients.[1]

In the case presented here, the patient opted for conservative treatment, with over-the-counter nonsteroidal anti-inflammatory medications and expectant management. The patient was counseled to follow up in 3 months for possible repeat CT and clinical evaluation. If clinical symptoms or radiologic findings persist, laparoscopy may be considered.


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