Presentation
Patient presents with left loin pain that has been ongoing for a couple of weeks.
Patient Data
Technique:
Single-phase quad-bolus IV contrast-enhanced polychromatic spectral CT.
Findings:
Large bowel: Focal epiploic appendagitis seen on the mid descending colon anterior margin. The liver demonstrates mild fatty changes. Nil abnormalities in small bowel, pancreas, spleen, adrenals, kidneys, bladder, omentum or mesentery. Nil hernias, free gas, free fluid or stones in the gallbladder. Lymph nodes: nil by size criteria. No acute vasculopathy. CBD and portal vein are of normal caliber. Lung bases are clear.
Conclusion: The patient's symptoms are likely secondary to focal acute epiploic appendagitis of the mid-segment left descending colon.
Spectral CT showing focal epiploic appendagitis in the mid descending colon anterior margin.
Arrows pointing to the epiploic appendagitis seen on the mid descending colon anterior margin.
Case Discussion
Patients with epiploic appendagitis usually present with acute or subacute lower abdominal pain as in the case of this patient 1. Pain is usually localized to the left side of the abdomen in 60-80% of patients 1.
CT of the abdomen is the modality of choice for diagnosing epiploic appendagitis, it also allows for the exclusion of sinister causes of abdominal pain 1,2,3.
On imaging, epiploic appendagitis appears as oval-shaped, paracolic mass with thickening of the peritoneal lining. The above images clearly demonstrate the classical ring or dot sign associated with epiploic appendagitis (fat density ovoid lesion and high attenuation central focus) 1,2,3.
Management: Epiploic appendagitis is a non-surgical self-resolving pathological process that is usually managed conservatively. Surgery is considered if the patient is clinically deteriorating and the epiploic appendagitis is complicated by abscess, intussusception or bowel obstruction 1,3. In this case, the complicated epiploic appendagitis was ligated and surgically resected.
Case courtesy of Dr Zane Sherif.
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