Acute epiploic appendagitis: Radiologic and clinical features of 12 patients

Abstract

HighlightsThe diagnosis of epiploic appendagitis is crucial; CT scan imaging is necessary for an accurate diagnosis.CT scan findings are an ovoid mass lesion of fat density, surrounded by a dense rim in all cases.Non-surgical management is preferred with CT controls.

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“…However, the term ‘Epiploic appendagitis’ was first introduced by Lynn et al in 1956 (13). These appendages are usually 0.5–5 cm in length, 50–100 in number (3–8, 10–12), and are attached to colonic wall by vascular stalks containing 1–2 arterioles and a single venule (8, 11). Their limited blood supply and lobulated shape increase their mobility and risk of torsion (5, 12).…”

“…These appendages are usually 0.5–5 cm in length, 50–100 in number (3–8, 10–12), and are attached to colonic wall by vascular stalks containing 1–2 arterioles and a single venule (8, 11). Their limited blood supply and lobulated shape increase their mobility and risk of torsion (5, 12). As epiploic appendages are widespread in colon, EA can occur anywhere; however, the most common sites are rectosigmoid junction (57%), ileocecal region (26%), ascending colon (9%), transverse colon (6%), and descending colon (2%) (10).…”

“…EA is uncommon in children as epiploic appendages are not well developed (10). EA has been associated with obesity and unaccustomed exercise (8, 10, 12). The fact that obese people tend to have larger and more prominent epiploic appendages makes them prone for EA (8).…”

“…Diagnosis is usually made by contrast-enhanced CT scan or ultrasonography of abdomen (1–4, 6–10, 12). Ultrasonography findings most commonly include a solid, non-compressible, hyperechoic oval mass with a hypoechoic rim (1, 6, 7, 9, 12). The pathognomic finding on CT abdomen is a hyperattenuated 2–3 cm oval-shaped fat density with paracolonic inflammation and fat stranding (3–12), as in our patient.…”

“…Ultrasonography findings most commonly include a solid, non-compressible, hyperechoic oval mass with a hypoechoic rim (1, 6, 7, 9, 12). The pathognomic finding on CT abdomen is a hyperattenuated 2–3 cm oval-shaped fat density with paracolonic inflammation and fat stranding (3–12), as in our patient. Absence of hyperattenuating ring favors omental infarction, while long segment colonic wall thickening extending more than 5 cm with presence of colonic diverticula with inflammation or abscess in mesocolon favors acute diverticulitis (12).…”