Epiploic appendagitis is an uncommon disease. This is a self-limiting benign inflammatory process of the fat mane of the colon. This pathology is often overlooked when diagnosing abdominal pain causes.
Colonic fat mane surgery: These are fatty structures that originate in the colon and are surrounded by the peritoneum. There are about 50-100 adipose mane distributed from the cecum to the rectal junction – sigmoid colon, especially the sigmoid colon (80%) and the descending colon (12%). They are arranged in rows along the muscle strips along the colon.
Clinical and subclinical: acute or subacute abdominal pain, usually ¼ lower left abdomen. The pain may be local or a symptom of peritonitis. Most patients received the onset of acute abdominal pain and the localized abdominal wall reaction. Symptoms improve gradually over 5-7 days, in some cases up to 2-3 weeks. There may be no fever or mild fever, WBC and CRP are normal or slightly increased.
Diagnosis can be done under ultrasound with a dense, thick, oval, and non-collapsed mass at the site of the most resistant to the abdominal wall, usually surrounded by a poor echogenic border. This poorly echogenic border is due to the inflammatory response of the peritoneal leaf surrounding the fat mane.
|Figure: a, b The ultrasonic feature of adipose mane was found in a 35-year-old female patient, which is a thick echogenic mass (asterisk) with a poorly echogenic border (arrows), near the sigmoid colon (S). c This same lesion was detected on computed tomography, manifested by a decrease in fat signal and a high-density border (arrows).|
|Picture: Vertical ultrasonic slices (a) and horizontal (b) of colitis in a 42-year-old male patient with acute abdominal pain. a Ultrasound shows that in the left pelvic fossa, at the most resistant position, there is a thick echolytic mass (asterisk) about 3cm in diameter, thin echogenic border (arrows) next to the sigmoid colon ( S). b Similar lesions (arrows) in cross-section show a poorly echogenic area inside the block, possibly due to a disabled blood vessel or a hemorrhagic condition.|
The disease is usually self-limited and benign, so unnecessary intervention should be avoided. It can be similar to other acute abdominal pain conditions such as diverticulitis, cholecystitis, and appendicitis.
1. Chen JH, Wu CC, Wu PH (2011) Epiploic appendagitis: an uncommon and easily misdiagnosed disease. J Dig Dis 12: 448–452
2. Choi YU, Choi PW, Park YH et al (2011) Clinical characteristics of primary epiploic appendagitis. J Korean Soc Coloproctol
3. Ghahremani GG, White EM, Hoff FL et al (1992) Appendices epiploicae of the colon: radiologic and pathologic features. Radiographics 12: 59–77