Epiploic appendagitis

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[edit] Discussion

  • Torsion of epiploic appendages resultants in vascular occlusion that leads to ischemia: this has been implicated as the cause of acute epiploic appendagitis.
  • The venous component of the appendage is affected first, because each appendage is supplied by paired arteries but drained by only one vein.

  • Acute epiploic appendagitis is associated with obesity, hernia, and unaccustomed exercise.
  • Inflammation of the epiploic appendages is self limited in the majority of patients. Rarely, acute epiploic appendagitis may result in adhesion, bowel obstruction, intussusception, peritonitis, and/or abscess formation.

  • Condition most commonly manifests in the 4th to 5th decades of life, predominantly in men.
  • Clinically, acute epiploic appendagitis manifests with acute onset of pain, most often in the left lower quadrant, and this symptom often leads to its being mistaken for acute diverticulitis.
  • When acute epiploic appendagitis involves the cecum or ascending colon, it may be mistaken clinically for acute appendicitis.
  • Most common sites of acute epiploic appendagitis, in order of decreasing frequency, are areas adjacent to the sigmoid colon, the descending colon, and the right hemicolon.

[edit] Imaging Findings

[edit] CT

  • Most common CT feature in acute epiploic appendagitis is an oval lesion less than 5 cm in diameter (typical diameter range is 1.5–3.5 cm) that has attenuation equivalent to that of fat, abuts the anterior colonic wall, and is surrounded by inflammatory changes.
  • The wall of the colon may be thickened but is most often normal in thickness.
  • Although the presence of a central area of high attenuation due to venous thrombosis is useful for diagnosis, absence does not preclude a diagnosis of acute epiploic appendagitis.

[edit] Images

Patient #1: CT demonstating epiploic appendagitis in a patient with right lower quadrant pain

Patient #2: CT demonstating epiploic appendagitis in a patient with right lower quadrant pain

[edit] See Also

[edit] External Links

[edit] References