Acute epiploic appendagitis

Occurs as a result of torsion of a epiploic appendage, with subsequent vascular infarction. Most commonly occurs at the sigmoid and mimics diverticulitis, presenting with left iliac fossa pain. Right sided pain mimicking appendicitis is also seen.

It is most commonly seen in the 4th -5th decade, and is more frequent in unfit, overweight, diabetic males. Usually does not have an associated fever or white cell increase.

Until the advent of widely available MDCT, epiploic appendagitis was not diagnosed pre operatively, and as it is a self limiting benign condition, avoiding an unnecessary operation is desirable.

Classically it appears as a fat density rounded structure less than 5cm in diameter, abutting the colonic wall and surrounded by inflammatory changes. Often it also has a central vascular 'dot' representing the thrombosed vascular pedicle.

DDx

• Omental infarction
• Mesenteric panniculitis
• Diverticulitis or other inflammatory process
• infalmmatory malignancy of the colon