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. 2016:28:219-222.
doi: 10.1016/j.ijscr.2016.09.015. Epub 2016 Oct 6.

Acute epiploic appendagitis: Radiologic and clinical features of 12 patients

Dali Nadida  1 , Ali Amal  1 , Marzouk Ines  2 , Moussa Makram  3 , Manamani Amira  1 , Ben Farhat Leila  1 , Hendaoui Lotfi  1
Affiliations

Acute epiploic appendagitis: Radiologic and clinical features of 12 patients

Dali Nadida et al. Int J Surg Case Rep. 2016.

Abstract

Purpose: The aim of this work is to explain the clinical features and the imaging findings of primitive epiploic appendagitis in 12 patients.

Materials and methods: Twelve patients were examined in 2 University hospitals between January 2011 and June 2016. Their medical charts have been reviewed. Nine patients have undergone enhanced CT examination and only two among them, have had at first an abdominal ultrasound.

Results: The age ranged between 36 and 65 years old. All the patients consulted for an acute abdominal pain in most of the cases in the left iliac fossa with no elevated body temperature nor a significant elevation of the inflammation markers. Ultrasound features showed a hyper-echoic mass surrounded by a hypo-echoic peripheral ring. CT scan images showed a fat ovoid lesion that corresponds to the inflamed Appendix epiploica with a peripheral hyper-attenuating rim and in some cases the central "dot sign" referring to the thrombosed vessel. Only 4 patients underwent surgery.

Conclusion: For its non-specific clinical presentation, that can mimic other surgical affections, and its rather non-operative treatment, the diagnosis of epiploic appendagitis is crucial. Ultrasound and especially CT scan imaging are necessary for an accurate diagnosis.

Keywords: Acute abdomen; Computed tomography; Diagnosis; Management; Ultrasonography.

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Figures

Fig. 1
Fig. 1
Ultrasoud images (using a high frequency probe): A hyperechoic mass surrounded by a hypoechoic rim (head arrow) with a hypoechoic central element “the dot sign” (arrow).
Fig. 2
Fig. 2
Axial CT scan showing an ovoid fat density mass surrounded by a hyper-attenuating ring (arrow) situated on the anti-mesenteric side of the descendant colon with adjacent fat stranding.
Fig. 3
Fig. 3
axial CT Image showing the ovoid fat lesion with the hyper-attenuating peripheral rim. Note the associated localized colon wall thickening (arrow). There is an associated localized peritoneum thickening (head arrow).
Fig. 4
Fig. 4
CT scan image showing a mass that abuts the caecum with an ill defined hyperattenuting surrounding ring (arrow).
Fig. 5
Fig. 5
intraoperative laparoscopic view: dissecion of the infarcted epiploic appendage.
See this image and copyright information in PMC

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