Epiploic appendagitis

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Epiploic appendagitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Epiploic appendagitis is a benign self-limiting inflammatory process of the colonic epiploic appendices.

History

Epiploic appendagitis (EA) has also been called appendicitis epiploica or appendagitis. To avoid further confusion with acute appendicitis the EA term is used more commonly now. EA is usually diagnosed by CT scanning and has become more widely recognized given today's higher resolution scanners. Epiploic appendages are small fat-filled sacs situated near the lining of the colon. They may become acutely inflamed as a result of torsion (twisting) or venous thrombosis.

Clinical Course

The average patient is about 40 years old and develops acute abdominal pain which may be left-sided, right, or central. The pain is sharp and stabbing and may be associated with nausea or vomiting. Fever is usually absent. The symptoms from EA often mimic acute appendicitis, diverticulitis, or cholecystitis. Initial lab studies are usually normal. Typically, a CT scan is ordered to help exclude more serious or surgical problems (above) and the inflammatory changes of EA are seen coincidentally. EA follows a benign, self-limiting course and may be treated with analgesics and expectant observation. The usual time course is about one week. A correct diagnosis is important to avoid unnecessary surgical or medical intervention.

CT

  • Most common CT feature in acute epiploic appendagitis is an oval lesion less than 5 cm in diameter (typical diameter range is 1.5–3.5 cm) that has attenuation equivalent to that of fat, abuts the anterior colonic wall, and is surrounded by inflammatory changes.
  • The wall of the colon may be thickened but is most often normal in thickness.
  • Although the presence of a central area of high attenuation due to venous thrombosis is useful for diagnosis, absence does not preclude a diagnosis of acute epiploic appendagitis.

Patient #1: CT demonstating epiploic appendagitis in a patient with right lower quadrant pain

Patient #2: CT demonstating epiploic appendagitis in a patient with right lower quadrant pain

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