Acute Epiploic Appendagitis and Its Mimics

Abstract

Acute epiploic appendagitis most commonly manifests with acute lower quadrant pain. Its clinical features are similar to those of acute diverticulitis or, less commonly, acute appendicitis. The conditions that may mimic acute epiploic appendagitis at computed tomography (CT) include acute omental infarction, mesenteric panniculitis, fat-containing tumor, and primary and secondary acute inflammatory processes in the large bowel (eg, diverticulitis and appendicitis). Whereas the location of acute epiploic appendagitis is most commonly adjacent to the sigmoid colon, acute omental infarction is typically located in the right lower quadrant and often is mistaken for acute appendicitis. It is important to correctly diagnose acute epiploic appendagitis and acute omental infarction on CT images because these conditions may be mistaken for acute abdomen, and the mistake may lead to unnecessary surgery. The CT features of acute epiploic appendagitis include an oval lesion 1.5-3.5 cm in diameter, with attenuation similar to that of fat and with surrounding inflammatory changes, that abuts the anterior sigmoid colon wall. The CT features of acute omental infarction include a well-circumscribed triangular or oval heterogeneous fatty mass with a whorled pattern of concentric linear fat stranding between the anterior abdominal wall and the transverse or ascending colon. As CT increasingly is used for the evaluation of acute abdomen, radiologists are likely to see acute epiploic appendagitis and its mimics more often. Recognition of these conditions on CT images will allow appropriate management of acute abdominal pain and may help to prevent unnecessary surgery.

Torsion of epiploic appendices: An uncommon cause of acute abdomen

“…Çıkan kolondaki AE'lerin veya sigmoid kolonun batın sağ alt kadrana göç etmesi nedeniyle sigmoid kolondaki AE'lerin inflamasyonu sonucu gelişen PAE, akut apandisit tablosunu taklit edebilir. Ayrıca yine yerleşim yerine göre akut kolesistit, akut divertikülit gibi diğer cerrahi patolojileri de taklit edebileceğinden, özellikle çocuk hastalarda operasyon sırasında PAE tanısı konulmaktadır (5,6) . Erişkin hasta grubunda PAE tanısı konulmasında USG ve BT yardımcı olmaktadır.…”

A Rare Cause of Left Lower Quadrant Pain at a Rare Localization of Colon: Primary Acute Epiploic Appendagitis of Descendant Colon

“…The 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 [8].…”

Benign Diseases of the Colon and Rectum (incl. CT colonography)

“…Chronically, an infarcted epiploic appendix may calcify. Epiploic appendagitis is a self-limiting condition and does not require invasive intervention [41]. …”