- 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.
- Sigmoid colon –> left hemicolon –> right hemicolon
- Can occur any any age, but more common in 40-50 yo
- Can mimic appendicitis with fever, N&V and RUQ pain
- Bacterial superinfection –> abscess
- Peritoneal adhesion due to fibrosis –> large bowel obstruction
- 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
- IV fluid and pain meds
- Role of surgery:
– Persistent/recurring pain