Spontaneous epiploic apendagitis
Acute onset right iliac fossa pain. No nausea, fever or leukocytosis.
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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.
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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).