Spontaneous epiploic apendagitis

Case contributed by Dr Sophie O'Dowd

Presentation

Acute onset right iliac fossa pain. No nausea, fever or leukocytosis.

Patient Data

Age: 45
Gender: Male
Modality: CT

Inflammatory fat stranding in the region of the anterior caecum/ascending colon, just superior to the ileo-caecal valve is apparent. Reactive localised lymphadenopathy is present. No abdominopelvic free gas or free fluid. Normal calibre small and large bowel. Normal appearance of the vermiform appendix. Overall appearances are consistent with spontaneous epiploic appendagitis.

Case Discussion

Epiploic appendages are fatty outpouchings of the colonic serosa. Epiploic appendage torsion and thrombosis, resulting in ischaemia, are the two main causes of epiploic appendagitis. The ileo-caecal region is the second most commonly area affected. In this case it was important to positively identify the vermiform appendix as normal in appearance because management of epiploic appendagitis is non-surgical. The location of the ileo-caecal valve helped to determine the origin of the vermiform appendix (inferior) and reliably separate this from the pathology (superior).      

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Case Information

rID: 44670
Case created: 1st May 2016
Last edited: 2nd May 2016
Inclusion in quiz mode: Included

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