Clinicopathological differences in attached versus loose infarcted epiploic appendages: an analysis of 52 cases

Abstract

BackgroundEpiploic appendages are fatty peritoneal structures on the external surface of the colon that can infarct and become necrotic in situ or autoamputate.AimsTo describe clinicopathological features of infarcted epiploic appendages (IEAs).MethodsWe reviewed 52 IEAs from 49 patients, recording numerous clinical and pathological characteristics, which were compared across attached and loose IEAs.ResultsTwenty-seven IEAs were attached, and 23 were loose; location was unclear in 2. Most were incidental; 3 attached cases caused ‘appendagitis’. Most (31, 60%) had a classic ‘egg-like’ appearance. Common findings included fat necrosis (84%), calcification (67%) and fibrosis (58%). Attached cases had a larger mean size (1.8 cm vs 1.3 cm, p=0.030) and were more often haemorrhagic (37% vs 4%, p=0.0064) and inflamed (67% vs 13%, p=0.0002). Loose cases were more often necrotic (100% vs 74%, p=0.011).ConclusionsIEAs have different morphology whether they remain attached to peritoneum or become necrotic and detached. Attached cases may cause symptoms.

Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases

“…Therefore, to the best of our knowledge, our study is considered the most extensive EPA study (n = 156) in contemporary literature. 7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] EPAs were removed surgically in 3.8% of the cases, and appendectomy was performed in 5% of the cohort. Removing a normal appendix in EPA cases without clear pathology is a surgeon's preference.…”

“…Searching the literature between 2000 and 2023 revealed that the large, reported study had 58 EPA cases. Therefore, to the best of our knowledge, our study is considered the most extensive EPA study ( n = 156) in contemporary literature 7,9–25 . EPAs were removed surgically in 3.8% of the cases, and appendectomy was performed in 5% of the cohort.…”

“…The attached type of EPA is often hemorrhagic or inflamed, whereas loose types are often necrotic. 7 In this study, we explore the incidence, modalities of diagnosis, and treatment options for epiploic appendagitis.…”

“…Histologic examination of EPA reveals fatty necrosis, fibrinoleukocytic exudate, and signs of acute infarction and inflammation. The attached type of EPA is often hemorrhagic or inflamed, whereas loose types are often necrotic 7 . In this study, we explore the incidence, modalities of diagnosis, and treatment options for epiploic appendagitis.…”