Case of the Month

Clinical

Left iliac fossa pain, is this diverticulitis?

 

Diagnosis

Epiploic appendagitis

 

Investigation

Left Image: Axial CT showing ovoid fat lesion with surrounding hyperdense ring containing central dot and adjacent fat stranding lying adjacent to the sigmoid colon. Non inflamed diverticula are seen in the adjacent sigmoid colon.

Centre Image: Coronal CT reconstruction of the same patient

Right Image: Axial CT in a different patient imaged for possible renal colic. In this case there is a hyperdense ring surrounding a fat density lesion adjacent to large bowel with adjacent fat stranding but no central dot.

 

Discussion

Epiploic appendages are small serosal lined protrusions arising from the antimesenteric border of the colon containing fat and vessels.

Epiploic appendagitis arises due to torsion and venous thrombosis of these protrusions with subsequent infarction.

Clinical presentation is typically of acute onset lower abdominal pain. This typically abates after one week. No specific treatment is required other than analgesia if diagnosed prior to any surgery.

The radiological differential diagnosis include diverticulitis and omental infarction.

Epiploic appendagitis typically appears as an ovoid fat density lesion adjacent to the antimesenteric surface of the colon with a high density enhancing ring and adjacent fat stranding. There may be a central dot representing the thrombosed vessels. Sometimes these can go on to calcify.