Keywords:
Abdomen, Gastrointestinal tract, Emergency, CT, Complications, Inflammation
Authors:
P. Carcione, G. Lo Re, G. Maniaci, G. Carcione, M. C. Galfano, M. Galia, G. La Tona, S. Salerno, M. Midiri; Palermo/IT
DOI:
10.1594/ecr2013/C-0597
Results
Epiplooic appendages are fatty appendages originating in two rows parallel to the toenia coli.
Their limited blood supply together with their pedunculated shape and excessive mobility make them prone to torsion and ischemic infarctions.
PEA refers to inflammation in the epiplooic appendages caused by spontaneous torsion of its vascular stalk.
All patients came to our attention with acute abdominal pain: 5 patients had left lower quadrant pain,
2 patients right lower quadrant pain.
All patients were afebrile and only 4 showed mild leukocitosis.
Phisical examination revealed a localized abdominal tenderness in all patients
- In six of our patients the inflamed epiploic appendage on CT appears as a 1-4 cm ovoid pericolic lesion with fat density surrounded by a 2-3 mm hyperdense rim,
sign of inflamed visceral peritoneal covering (fig.1): this represents the diagnostic sign of PEA. Other findings were asimmetric wall thickening of the adjacent side of the colon and fat stranding (fig.
2).
These patients were treated conservatively with oral FANS and antibiotics.
- One patient showed at first MDCT a multiloculated mass next to the right flexure of the colon (fig.
3) that was diagnosed as an abscess arising from a complicated PEA after surgery.