Secondary epiploic appendagitis

Clinical History

A patient presented with a sudden onset of abdominal pain in the left lower quadrant, and fever.

Imaging Findings

The patient was admitted to the hospital because of a sudden onset of abdominal pain in the left lower quadrant and she was febrile. A physical examination done revealed abdominal tenderness on the left with minimal guarding. Laboratory test results revealed that an inflammatory process was involved. The diagnosis was made using computed tomography (CT) (Fig.1).

Discussion

Primary epiploic appendagitis may be differentiated from secondary epiploic appendagitis, which is the result of a pericolic inflammatory process. In this case, a sonographic diagnosis may be difficult to make as it does not reveal the underlying inflammatory process, and CT is, therefore, the preferred method of diagnosis. Unlike primary epiploic appendagitis, on CT, it is known that several epiploic appendices are invovled [1]. Appendages involved in secondary epiploic appendagitis are visible using CT because of the presence of a surrounding fluid, whereas the single appendage involved in primary epiploic appendagitis is visible because of the thickened visceral peritoneal lining [2]. Diverticulitis of the colon is by far the most common cause of secondary epiploic appendagitis [3]. This association arises from the close anatomic relationship between the colonic diverticula and the appendices epiploicae. These structures are typically located along the two antimesenteric taeniae, and most diverticula protrude beneath or immediately adjacent to the appendices epiploicae. Diverticulitis usually manifests as an extraluminal, pericolic process that may, therefore, affect the neighbouring appendages with secondary inflammation and sometimes ischaemic changes. The peak incidence of secondary epiploic appendagitis occurs later than for primary epiploic appendagitis and corresponds to the peak incidence of diverticulitis of the colon. Secondary epiploic appendagitis may also occur in association with other inflammatory disorders of the colon or abdominal viscera close to colon segments (Crohn colitis, ileo-caecal appendicitis, cholecystitis, pancreatitis, and tubo-ovarian abscesses) [4].

Differential Diagnosis List

Final Diagnosis

Secondary epiploic appendagitis complication of diverticulitis.

URL:	https://www.eurorad.org/case/3041
DOI:	10.1594/EURORAD/CASE.3041
ISSN:	1563-4086