4 days of LIF pain and rebound tenderness.
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At the anterior aspect of the distal descending colon there is an ovoid structure of fat density measuring 27 x 7 mm with adjacent fat stranding. No free fluid or gas.
The remainder of the large and small bowel are normal. No evidence of diverticular disease. The appendix is normal. Faecal material throughout the ascending and transverse colon.
The liver, spleen, adrenals, kidneys and pancreas are unremarkable. No intra-abdominal or inguinal lymphadenopathy. Tiny right pleural effusion. No suspicious osseous lesions.
Findings are consistent with epiploic appendagitis.
This case demonstrates the typical appearance and location of epiploic appendagitis, where there is either torsion of an epiploic appendage or spontaneous thrombosis of the epiploic appendage central draining vein. It can be primary or secondary to an adjacent inflammatory process. It can affect any part of the colon, but is most common in the sigmoid and descending colon, likely due to the distribution of the appendages.
The diagnosis has become more common with the routine use of CT for the investigation of abdominal pain. Epiploic appendagitis on the left side is in the differential for LIF pain, along with the more common sigmoid diverticulitis. Epiploic appendagitis on the right side is in the differential for RIF pain, along with the more common acute appendicitis.
Management is conservative with NSAIDS and analgesia. Rarely is there a need for surgical management.
- 1. Almeida AT, Melão L, Viamonte B et-al. Epiploic appendagitis: an entity frequently unknown to clinicians-diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol. 2009;193 (5): 1243-51. doi:10.2214/AJR.08.2071 - Pubmed citation
- 2. Boardman J, Kaplan KJ, Hollcraft C et-al. Radiologic-pathologic conference of Keller Army Community Hospital at West Point, the United States Military Academy: torsion of the epiploic appendage. AJR Am J Roentgenol. 2003;180 (3): 748. AJR Am J Roentgenol (full text) - Pubmed citation