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Epiploic Appendagitis
Appendicitis Epiploica

General Considerations

  • Uncommon cause of acute abdominal pain
  • Occurs most often in men in 4th and 5th decade
  • Inflammation of epiploic appendages (appendices)
    • Peritoneal outpouchings originating from serosal surface of colon
      • Contain blood vessels and fat
  • Diagnosis requires cross-sectional imaging
  • Inflammation may be caused by venous occlusion
  • “Secondary” epiploic appendagitis is caused by inflammation of an adjacent structure

Clinical Findings

  • Findings resemble acute diverticulitis or appendicitis
  • Usually left lower quadrant abdominal pain
  • Fever is usually absent or mild
  • White cell count is usually normal
  • Vigorous exercise and obesity have been postulated as facilitating torsion of the appendage

Imaging Findings

  • 1.5-3.5 cm fat density lesion with surrounding inflammatory changes
  • Usually abuts anterior wall of sigmoid colon
  • Central, high density focus within fat (54%)
    • Probably thrombosed blood vessel
  • Colon wall thickening is unusual
  • Changes resolve within 6 months
  • Occasionally, fat necrosis may lead to calcification of the appendage
  • On US
    • Echogenic ovoid mass at point of tenderness
    • Hypoechoic ring (swelling of serosa)

Differential Diagnosis

  • Mesenteric panniculitis
  • Diverticulitis
  • Trauma
  • Neoplasm, e.g. liposarcoma
  • Omental infarction
    • Lacks hyperdense ring
    • Typically located in the right lower quadrant
    • Between anterior abdominal wall and ascending or transverse colon

Treatment

  • Conservative treatment with pain medication
    • Symptoms subside within a week and CT scan returns to normal by 6 months
  • Non-surgical

Complications

  • Rarely, adhesions, obstruction, peritonitis, abscess formation

Prognosis

  • Self-limited disease should result in complete resolution

epiploic appendagitis

epiploic appendagitis

Epiploic Appendagitis. Two axial CT scans of the lower abdomen show the classical findings of an oval, fat-containing mass abutting the sigmoid colon (red arrow) with surrounding inflammatory stranding of the fate (red circle). There is a characteristic dense focus within the fatty density which may represent a thrombosed vessel or hemorrhage.
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Singh, A; Gervais, D, Hahn, P, Rhea, J and Mueller, P. CT Appearance of Acute Appendagitis    AJR 2004;183:1303–1307  

Singh, A; Gervais, D, Hahn, P, Sagar, P, Mueller, P and Novelline, R.  Acute Epiploic Appendagitis and Its Mimics   RadioGraphics 2005;25:1521-1534