An epiploic appendage on the serosal surface of the colon may become inflamed and necrotic, causing focal abdominal pain. It is often not diagnosed until surgery because it is not considered in the differential diagnosis.


Possible causes:

(1) torsion around its long axis with interruption of the blood supply

(2) vascular thrombosis


Clinical features:

(1) rapid onset of sharp, localized abdominal pain in the left or right lower quadrant (the appendages are most common along the cecum and sigmoid colon)

(2) point tenderness

(3) absence of fever and significant leukocytosis with a slight increase in CRP or ESR

(4) imaging studies (ultrasonography, CT scan) can identify the process prior to surgery

(5) excision of an inflamed and/or necrotic epiploic appendage

(6) exclusion of other causes for the abdominal pain (appendicitis, diverticulitis, etc).


Findings on imaging studies:

(1) CT scan - small oval mass with an attenuation equivalent to fat

(2) ultrasonography - small oval mass that is hyperechoic with a small hypoechoic rim


A necrotic appendage may become detached from the colon, resulting in an intraperitoneal loose body with fat necrosis and possibly dystrophic calcification.


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