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Abdomen » Mesentry And Omentum
Acute epiploic appendagitis
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Author(s) :
Danilo Sirigu, MD
 
Presentation 71-year-old woman patient with left lower quadrant pain. The abdominal examination was normal except for obesity and significant tenderness upon superficial palpation in the left lower quadrant of the abdomen.
 
 
Caption: Real time ultrasound left lower quadrant
Description: Sonography at the site of severe abdominal pain demonstrated an ovoid, hyperechoic, non compressible mass adjacent to the colonic wall. Color Doppler showed no flow in the lesion.
 
 
Caption: CT Scan
Description: CT scan shows fat-density lesion with surrounding hyperdense rim and inflammation abutting the sigmoid colon and anterior abdominal wall musculature.
 
Differential Diagnosis acute diverticulitis
appendicitis
acute epiploic appendagitis

 
Final Diagnosis acute epiploic appendagitis
 
Discussion Acute epiploic appendagitis is an uncommon cause of abdominal pain,  that occurs secondary to torsion or spontaneous venous thrombosis of a draining vein from the serosal surface of the colon.

Clinically, it is most often mistaken for acute diverticulitis.

Acute epiploic appendagitis is associated with obesity and  hernia .

Rarely, acute epiploic appendagitis may result in adhesion, bowel obstruction, intussusception, intraperitoneal loose body, peritonitis .

Epiploic appendagitis is a self-limiting disease that has been reported in approximately 1% of patients clinically suspected of having appendicitis .

 
Case References
  1. Lee YC, Wang HP, Huang SP, Chen YF, Wu MS, Lin JT. Gray-scale and color Doppler sonographic diagnosis of epiploic appendagitis. J Clin Ultrasound 2001;29:197 -199
  2.  Sirvanci M, Tekelioglu MH, Duran C, Yardimci H, Onat L, Ozer K. Primary epiploic appendagitis: CT manifestations. Clin Imaging 2000;24:357 -361
  3. Van Breda Vriesman AC, Puylaert JB. Epiploic appendagitis and omental infarction: pitfalls and look-alikes. Abdom Imaging 2002; 27:20 -28
  4. Acute epiploic appendagitis and its mimics.  Singh AK, Gervais DA, Hahn PF, Sagar P, Mueller PR, Novelline RA. 1: Radiographics. 2005 Nov-Dec;25(6):1521-34.   http://www.ncbi.nlm.nih.gov/pubmed/16284132?dopt=Abstract

 
Technical Details This case was provided courtesy of Dr. Danilo Sirigu and the EchoMovies web site at www.ecomovies.it