Epiploic appendagitis

Anatomy

  • Numerous epoploic appendages arise from the serosal surface of colon.
  • They are attached to the surface by a vascular stalk.
  • Torsion of the stalk or venous thrombosis can cause ischemia and epiploic appendagitis.

Location

  • Sigmoid colon –> left hemicolon –> right hemicolon

Epidemiology

  • Can occur any any age, but more common in 40-50 yo

Clinical presentation

  • Can mimic appendicitis with fever, N&V and RUQ pain

Complications

  • Bacterial superinfection –> abscess
  • Peritoneal adhesion due to fibrosis –>  large bowel obstruction
  • Intussusception

Radiographic features

  • Ultrasound: a rounded noncompressible, hyperechoic mass in RUQ
  • CT: fat density ovoid lesion with a hyperdense rim. Local inflammatory changes eg fat stranding can be seen.
    – Occasionally, a hyperdense center can be seen due to clot in the vascular pedicle
    Untitled

Treatment

  • IV fluid and pain meds
  • Role of surgery:
    – Persistent/recurring pain
    – Complications

References:

  1. http://www.auntminnie.com/index.aspx?sec=olce&sub=cotx&pag=cpages&ce_id=7202&section_id=7241&pno=1
  2. http://radiopaedia.org/articles/epiploic-appendagitis
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