Presentation
Left iliac fossa pain.
Patient Data
Rather defined heterogeneous area of increased omental echogenicity with surrounded rim of fluid and reactive mesenteric lymph node, seen at the left iliac fossa just beneath the anterior abdominal wall.
Left iliac fossa shows an area of fat stranding just under the anterior abdominal wall, adjacent and anterior to the sigmoid colon with overlying mild peritoneal thickening. No related colonic wall thickening.
Case Discussion
Regarding the location as well as the radiological features, the possibility of epiploic appendagitis is considered and so conservative management was advised. It may or may not be associated with colonic wall thickening. Painful stranded fatty lesions of the abdomen adjacent to the colon are pretty much similar and may indistinguishable in many instances.
Other possible differentials are omental infarction and diverticulitis. Omental infarction usually occurs at the right side of the abdomen and in cases with history of recent abdominal surgery. Diverticulitis occurs in older age group on underlying diverticular disease of the colon, epicentered on a diverticulum and usually associated with bowel wall thickening.
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