Presentation
Right sided abdominal pain for the last three days.
Patient Data
Contrast-enhanced CT shows an irregularly shaped fatty structure at the mesocolon of the transverse colon, just distal to the hepatic flexure, with a hyperattenuating rim and inflammatory stranding of the adjacent peritoneal fat. There is no abscess or perforation. No diverticulitis or appendicitis.
Case Discussion
This 65-year-old patient presented with acute right-side abdominal pain for the last three days, without emesis, diarrhoea or fever. He came to the ER and was referred for CT imaging.
CT findings as detailed above are consistent with with primary (spontaneous) epiploic appendagitis, a relatively rare inflammatory or ischaemic disorder of the fatty appendices epiploicae of the colon sometimes pathologically correlating with a focal fat infarction.
The most frequent differential are diverticulitis and acute appendicitis (if right-sided).
The patient was conservatively treated with a combination of NSAIDs and the symptoms resolved after another five days.
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