Perigastric appendagitis

Case contributed by Dr Dalia Ibrahim

Presentation

Severe epigastric pain. Her physician suspects pancreatitis or pancreatic neoplasm.

Patient Data

Age: 45 years
Gender: Female
CT

CT scan showed a well-defined oval hyperdensity with a thin rim and engorged central vein in the lesser omentum, insinuated between the lesser curvature and the liver. It exerts mild mass effect on the lesser curvature. It's also associated with gastric mural thickening.

Normal CT appearance of the pancreas with no pancreatitis or masses.

Right hepatic lobe segment VIII hepatic focal lesion with typical marginal nodular enhancement pattern consistent with hemangioma.

Annotated image

CT scan showed a well-defined oval hyperdensity with a thin rim and engorged central vein in the lesser omentum, insinuated between the lesser curvature and the liver (arrows).

Case Discussion

Perigastric appendagitis is a rare inflammatory/ischemic process involving the perigastric ligaments (gastrohepatic, gastrosplenic and falciform ligaments).

Epiploic appendagitis, greater omental infarction, and perigastric appendagitis have similar mechanisms, clinical presentations, and radiological appearances.

Symptoms usually include acute and severe abdominal (epigastric) pain in absence of fever.

CT appearances consist of:

  • oval heterogeneous fat density focus with mild surrounding fat stranding along the course of the gastrohepatic (anterior to the stomach), gastrosplenic (posterior to the stomach), and falciform (anterior to the liver) ligaments

Case courtesy of Dr Amir Elhamy, Lecturer of radiodiagnosis at Theodor bilharz institute, Egypt.

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Case information

rID: 72584
Published: 1st Dec 2019
Last edited: 9th Dec 2019
Inclusion in quiz mode: Included

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