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
Related Anatomy
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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
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