Presentation
Three days of worsening right upper quadrant pain. Murphy's positive. Mild leukocytosis. Gallbladder normal on US.
Patient Data
Mild fat stranding adjacent to the hepatic flexure antimesenteric border with a prominent hyperdense vessel seen centrally. The focal inflammation abuts the anterior inferior edge of the liver and does not appear centered over any colonic diverticulum. The adjacent large bowel is not thickened. Moderate diverticulosis throughout the large bowel, uncomplicated.
The appendix is not identified. No paracaecal inflammatory changes. No mesenteric fat stranding. The remaining small bowel is unremarkable. No intra-abdominal free fluid or pneumoperitoneum.
Case Discussion
DDx is of focal omental infarction and epiploic appendagitis. This is not the typical location of epiploic appendagitis (usually anterior border of junction of descending and sigmoid colon).
The patient was discharged with oral analgesia and recovered uneventfully.