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Epiploic Appendagitis
Alexandra Medellin, MD; Stephanie R. Wilson, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Epiploic appendagitis (EA)
            • Synonyms

              • Appendicitis epiploicae, epiplopericolitis, or appendagitis
            • Definitions

              • Self-limited inflammation of epiploic appendage of colon
              • Primary EA is due to torsion along long axis, causing thrombosis of central vein
              • Secondary EA results from adjacent inflammatory process of colonic wall (diverticulitis or appendicitis) that affects otherwise healthy appendage
            • Risk Factors

              • Male sex, obesity, colonic diverticulosis, and strenuous exercise
            • Anatomy

              • Epiploic appendages are subserosal fat outpouchings that line entire colon in adults
              • They are located in 2 parallel rows next to taenia coli
              • Normally, they are 1-2 cm in thickness and 3-5 cm in length with largest 1 in sigmoid colon
              • They are supplied by vascular stalk with 1 or 2 arterioles from vasa recta and single draining vein
              • They are pedunculated in shape, have limited blood supply, and excessive mobility, which makes them prone to torsion
              • ~ 50-100 epiploic appendages are seen in adults
              • Single isolated appendages may be seen in appendix
              • Normal epiploic appendages are only visualized on US and CT in presence of ascites or inflammation
              • Its function is not well understood but is believed to provide protection to colonic vessels during dilatation and collapse of colon
              • Epiploic appendages may also be used for fat storage

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Trovato P et al: Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques. Pol J Radiol. 85:e178-82, 2020
                                  2. Menozzi G et al: Contrast-enhanced ultrasound appearance of primary epiploic appendagitis. J Ultrasound. 17(1):75-6, 2014
                                  3. Oztunali C et al: Radiologic findings of epiploic appendagitis. Med Ultrason. 15(1):71-2, 2013
                                  4. Kamaya A et al: Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics. 31(7):2021-34, 2011
                                  5. Schnedl WJ et al: Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 8(1):45-9, 2011
                                  6. Görg C et al: Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall Med. 30(2):163-7, 2009
                                  7. Sand M et al: Epiploic appendagitis--clinical characteristics of an uncommon surgical diagnosis. BMC Surg. 7:11, 2007
                                  8. Singh AK et al: CT appearance of acute appendagitis. AJR Am J Roentgenol. 183(5):1303-7, 2004
                                  9. Boardman J et al: Radiologic-pathologic conference of Keller Army Community Hospital at West Point, the United States Military Academy: torsion of the epiploic appendage. AJR Am J Roentgenol. 180(3):748, 2003
                                  10. Rioux M et al: Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 191(2):523-6, 1994
                                  11. Carmichael DH et al: Epiploic disorders. Conditions of the epiploic appendages. Arch Surg. 120(10):1167-72, 1985
                                  12. Thomas JH et al: Epiploic appendagitis. Surg Gynecol Obstet. 138(1):23-5, 1974
                                  13. Fieber SS et al: Appendices epiploicae: clinical and pathological considerations; report of three cases and statistical analysis on one hundred five cases. AMA Arch Surg. 66(3):329-38, 1953
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Epiploic appendagitis (EA)
                                            • Synonyms

                                              • Appendicitis epiploicae, epiplopericolitis, or appendagitis
                                            • Definitions

                                              • Self-limited inflammation of epiploic appendage of colon
                                              • Primary EA is due to torsion along long axis, causing thrombosis of central vein
                                              • Secondary EA results from adjacent inflammatory process of colonic wall (diverticulitis or appendicitis) that affects otherwise healthy appendage
                                            • Risk Factors

                                              • Male sex, obesity, colonic diverticulosis, and strenuous exercise
                                            • Anatomy

                                              • Epiploic appendages are subserosal fat outpouchings that line entire colon in adults
                                              • They are located in 2 parallel rows next to taenia coli
                                              • Normally, they are 1-2 cm in thickness and 3-5 cm in length with largest 1 in sigmoid colon
                                              • They are supplied by vascular stalk with 1 or 2 arterioles from vasa recta and single draining vein
                                              • They are pedunculated in shape, have limited blood supply, and excessive mobility, which makes them prone to torsion
                                              • ~ 50-100 epiploic appendages are seen in adults
                                              • Single isolated appendages may be seen in appendix
                                              • Normal epiploic appendages are only visualized on US and CT in presence of ascites or inflammation
                                              • Its function is not well understood but is believed to provide protection to colonic vessels during dilatation and collapse of colon
                                              • Epiploic appendages may also be used for fat storage

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • CT Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Trovato P et al: Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques. Pol J Radiol. 85:e178-82, 2020
                                                                  2. Menozzi G et al: Contrast-enhanced ultrasound appearance of primary epiploic appendagitis. J Ultrasound. 17(1):75-6, 2014
                                                                  3. Oztunali C et al: Radiologic findings of epiploic appendagitis. Med Ultrason. 15(1):71-2, 2013
                                                                  4. Kamaya A et al: Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics. 31(7):2021-34, 2011
                                                                  5. Schnedl WJ et al: Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 8(1):45-9, 2011
                                                                  6. Görg C et al: Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall Med. 30(2):163-7, 2009
                                                                  7. Sand M et al: Epiploic appendagitis--clinical characteristics of an uncommon surgical diagnosis. BMC Surg. 7:11, 2007
                                                                  8. Singh AK et al: CT appearance of acute appendagitis. AJR Am J Roentgenol. 183(5):1303-7, 2004
                                                                  9. Boardman J et al: Radiologic-pathologic conference of Keller Army Community Hospital at West Point, the United States Military Academy: torsion of the epiploic appendage. AJR Am J Roentgenol. 180(3):748, 2003
                                                                  10. Rioux M et al: Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 191(2):523-6, 1994
                                                                  11. Carmichael DH et al: Epiploic disorders. Conditions of the epiploic appendages. Arch Surg. 120(10):1167-72, 1985
                                                                  12. Thomas JH et al: Epiploic appendagitis. Surg Gynecol Obstet. 138(1):23-5, 1974
                                                                  13. Fieber SS et al: Appendices epiploicae: clinical and pathological considerations; report of three cases and statistical analysis on one hundred five cases. AMA Arch Surg. 66(3):329-38, 1953