Presentation
Acute onset right iliac fossa pain. No nausea, fever or leukocytosis.
Patient Data
Inflammatory fat stranding in the region of the anterior cecum/ascending colon, just superior to the ileocecal valve is apparent. Reactive localized lymphadenopathy is present. No abdominopelvic free gas or free fluid. Normal caliber 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 ischemia, are the two main causes of epiploic appendagitis. The ileocecal 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 ileocecal valve helped to determine the origin of the vermiform appendix (inferior) and reliably separate this from the pathology (superior).