Introduction: Primary epiploic appendagitis (PEA) is a disease with a good prognosis, and numerous reports have indicated that it can be cured without surgical treatment. However, there have been few reports on the necessity of anti-microbial therapy. There is also a paucity of information regarding what kind of management should be provided if the symptoms do not improve.
Case Report: A 69-year-old male presented to the hospital with left lower abdominal pain lasting 24 hours. Tenderness and rebound were found during the abdominal examination. The serum C-reactive protein level was mildly increased to 1.43 mg/dl, and the leukocyte count was 8,800/mm3. While abdominal radiography revealed no abnormalities, computed tomography (CT) scan revealed intraperitoneal panniculitis near the sigmoid colon. He was diagnosed with PEA. He received fluid therapy and levofloxacin intravenously. On the third day of hospitalization, his abdominal pain worsened. Subsequent CT scan reconfirmed this diagnosis. The administration of oral non-steroidal anti-inflammatory drugs (NSAIDs) led to improvement of the patient’s symptoms, laboratory abnormalities, and imaging findings. He was discharged from the hospital on the eighth day after initial onset.
Conclusion: Primary epiploic appendagitis is a self-limiting disease, and NSAIDs (rather than antibiotics) are effective for treating aseptic inflammation. It is important to differentiate PEA from acute abdomen requiring surgical treatment. Computed tomography scan is useful for diagnosing this disease and determining appropriate treatment.

Keywords: Antibiotics, Non-steroidal anti-inflammatory drugs, Primary epiploic appendagitis, Self-limiting disease