Gastrohepatic ligament appendagitis

Case contributed by Dr Yair Glick

Presentation

Left upper quadrant pain for 3 days, intensified on day of admission. Worsens when eating or moving.

Patient Data

Age: 35 years
Gender: Female

Fat-density structure in the gastrohepatic ligament with a vessel coursing through it and surrounding fat stranding.

Ultrasound

Focal fatty process in the gastrohepatic ligament, containing a hypoechoic focus at its center, likely representing an infarcted vessel - appearance characteristic of appendagitis and consistent with the finding on the CT study.

Case Discussion

It's not unusual for the radiologist to come up empty-handed when checking an abdominal CT scan for the etiology of localized pain.
That said, paying special attention to often-neglected anatomical areas (e.g. mesenteries and peritoneal reflections) after the usual suspects have been ruled out can sometimes pay out.

In contradistinction to epiploic appendagitis and omental infarction, perigastric appendagitis 1 is a rare entity. It is also probably underdiagnosed. It should, however, be sought in cases of upper abdominal pain where no other "culprit" has been implicated, especially when blood work comes back normal.

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