Pediatric Epiploic Appendagitis

  • Etiology:
    — Torsion of epiploic appendage – epiploic appendages are fat containing sacs of peritoneum on colonic serosal surface
    — Is self limiting inflammatory and ischemic process involving epiploic appendages of colon
  • Imaging CT:
    — Fat-density ovoid structure adjacent to colon
    — Thin high-density rim (hyperattenuating ring sign)
    — Surrounding inflammatory fat stranding
    — Thickening of the adjacent peritoneum
    — Central hyperdense dot representing thrombosed vascular pedicle
    — Inflamed appendage can be anywhere but is classically located on anterior aspect of sigmoid or descending colon
    — Normal appearing appendix
  • DDX: Omental infarct
  • Complications:
  • Treatment: Does not require surgery
  • Clinical:
    — Non-surgical cause of abdominal pain – a surgical “do not touch” lesion
    — Presents acutely
    — Mimics appendicitis with right lower quadrant pain and fever
    — Occurs in second to fifth decades

Radiology Cases of Epiploic Appendagitis

CT of epiploic appendagitis
Coronal (above left and above middle) and sagittal (above right) CT with contrast of the abdomen shows a fat-density ovoid lesion adjacent to the ascending colon with a thin high-density rim and surrounding inflammatory fat stranding and mild colonic wall thickening. The axial CT (below) shows the lesion to have a central hyperdense dot.