A rare cause of right-upper quadrant abdominal pain: Epiploic appendagitis of the hepatic flexure

Abstract

Epiploic appendagitis (EA) is an uncommon cause of acute abdominal pain that may mimic other causes of acute abdomen. Epiploic appendages are outpouching of fat tissue located on the external wall of the colon, being more numerous in the descending and sigmoid colon that account for up to 80% of EA cases. We present the case of a 59-year-old woman with right upper quadrant pain. Abdominal ultrasound and contrast-enhanced computed tomography suggested the diagnosis of epiploic appendagitis of the right colonic flexure. Our case highlights the fact that epiploic appendagitis may occur in unusual locations and must be included in the differential diagnosis of acute abdominal pain, in order to avoid unnecessary medical and surgical treatment.

Keywords: Acute abdomen; Computed tomography; Emergency radiology; Epiploic appendagitis; Ultrasound.

Fig. 1

Abdominal US showing a hyperechoic rounded mass in the right hypocondrium adjacent to the lower margin of IVb hepatic segment close to the ascending colon (white arrows in A and B). The mass is surrounded by a hypoechoic rim. Color Doppler US shows absent internal blood flow (B).

Fig. 2

Axial (A) and coronal (B) contrast-enhanced CT demonstrating a formation with heterogeneous adipose matrix and peripheral dense rim (white arrows in A and B) adjacent to the right colic flexure. The findings were consistent with epiploic appendagitis.