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KEY FACTS
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Imaging
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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
- 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
- Menozzi G et al: Contrast-enhanced ultrasound appearance of primary epiploic appendagitis. J Ultrasound. 17(1):75-6, 2014
- Oztunali C et al: Radiologic findings of epiploic appendagitis. Med Ultrason. 15(1):71-2, 2013
- Kamaya A et al: Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics. 31(7):2021-34, 2011
- Schnedl WJ et al: Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 8(1):45-9, 2011
- Görg C et al: Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall Med. 30(2):163-7, 2009
- Sand M et al: Epiploic appendagitis--clinical characteristics of an uncommon surgical diagnosis. BMC Surg. 7:11, 2007
- Singh AK et al: CT appearance of acute appendagitis. AJR Am J Roentgenol. 183(5):1303-7, 2004
- 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
- Rioux M et al: Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 191(2):523-6, 1994
- Carmichael DH et al: Epiploic disorders. Conditions of the epiploic appendages. Arch Surg. 120(10):1167-72, 1985
- Thomas JH et al: Epiploic appendagitis. Surg Gynecol Obstet. 138(1):23-5, 1974
- 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
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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
- 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
- Menozzi G et al: Contrast-enhanced ultrasound appearance of primary epiploic appendagitis. J Ultrasound. 17(1):75-6, 2014
- Oztunali C et al: Radiologic findings of epiploic appendagitis. Med Ultrason. 15(1):71-2, 2013
- Kamaya A et al: Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics. 31(7):2021-34, 2011
- Schnedl WJ et al: Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol. 8(1):45-9, 2011
- Görg C et al: Contrast-enhanced ultrasound of epiploic appendagitis. Ultraschall Med. 30(2):163-7, 2009
- Sand M et al: Epiploic appendagitis--clinical characteristics of an uncommon surgical diagnosis. BMC Surg. 7:11, 2007
- Singh AK et al: CT appearance of acute appendagitis. AJR Am J Roentgenol. 183(5):1303-7, 2004
- 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
- Rioux M et al: Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 191(2):523-6, 1994
- Carmichael DH et al: Epiploic disorders. Conditions of the epiploic appendages. Arch Surg. 120(10):1167-72, 1985
- Thomas JH et al: Epiploic appendagitis. Surg Gynecol Obstet. 138(1):23-5, 1974
- 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
