Presentation
Right iliac fossa pain and vomiting for 2 days.
Patient Data
Fat density tubular structure with surrounding hyperdense rim and fat streakiness seen adjacent to the anterolateral aspect of ascending colon. Associated mild bowel wall thickening and overlying peritoneal thickening at this region.
The appendix is elongated but not dilated. No appendicolith or peri-appendiceal fat streakiness.
No bowel-related mass or bowel dilatation. No pneumoperitoneum.
Features are suggestive of epiploic appendagitis.
Blue arrows point to the fat-density tubular structure with a hyperdense rim and surrounding inflammatory changes.
Case Discussion
Intraperitoneal focal fat infarctions (i.e. epiploic appendagitis or omental infarction) are due to acute inflammation of the intraperitoneal fat secondary to vascular compromise causing acute abdominal pain, mimicking acute appendicitis or acute diverticulitis.
They are usually self-limiting and managed conservatively. In this patient, diagnostic laparoscopy was performed due to persistent severe pain, which confirmed the diagnosis of epiploic appendagitis arising from the surface of the ascending colon. This was excised and the patient recovered uneventfully.
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