Epiploic appendages,
also known as epiploicae appendices,
are pedunculated,
adipose structures arising from the serosal surface of the large bowel.
There are approximately 50-100 of them arranged in two separate longitudinal rows,
extending from the cecum to the recto-sigmod junction,
located anteriorly along the taenia libera and postero-laterally along the taenia omentalis (which is missing in the transverse colon,
where only a single row is harbored).
Epiploic appendages are covered by peritoneum and typically measure 1-2 cm in thickness and 2-5 cm in length,
but they have been reported to be up to 15 cm long [1,2].
Each epiploic appendage is supplied by one or two small nutrient arteries branching from the vasa recta longa of colon and drained by a tortuous vein passing through its narrow pedicle.
Their limited blood supply,
associated with their pedunculated shape and excessive mobility,
make epiploic appendages prone to torsion and ischemic or hemorrhagic infarction [1,2].
Typically,
the epiploic appendages are visible on Computed Tomography (CT) images only when they are inflamed and/or surrounded by fluid [3].
Epiploic appendagitis is an uncommon cause of abdominal pain,
due to a benign,
self-limiting inflammatory or ischemic process involving epiploic appendages of colon.
Inflammation may occur as an acute primary process,
localized to one or several epiploic appendages,
or secondary to other conditions affecting adjacent organs,
such as diverticulitis,
appendicitis,
pancreatitis or cholecystitis [1].
Primary epiploic appendagitis is caused by torsion of a large and pedunculated epiploic appendix or spontaneous thrombosis of the venous outflow,
resulting in vascular occlusion and focal inflammation.
In literature,
this condition has a wide reported age range from 12 to 82 years,
but usually it affects patients in their 2nd to 5th decades of life,
with preponderance for women and obese individuals [1].
Classically,
primary epiploic appendagitis affects the sigmoid colon or cecum,
while is uncommon in the transverse colon.
Clinically,
this condition may mimic other diseases requiring surgery,
particularly diverticulitis or acute appendicitis.
On physical examination,
the patient will present with focal abdominal pain in the lateral lower quadrants of abdomen,
without significant guarding or rigidity.
Usually,
epiploic appendagitis spontaneously resolves within 5–7 days; surgery is not required and treatment is based on patient’s symptoms [1].
Albeit ultrasound has the advantage of been guided by the patients location of maximum tenderness,
nowadays CT is considerd the gold standard imaging technique for making a definite diagnosis of primary epiploic appendagitis [1,3].
In this educational exhibit,
we describe the most common CT imaging findings of epiploic appendagitis and provide brief notes about the anatomopathological correlation of the imaging.