Secondary Epiploic Appendagitis – Report of Three Cases with CT Findings

Abstract

ABSTRACT Epiploic appendages are the fat-containing peritoneal pouches usually seen in the anti-mesenteric border, adjacent to the large bowel loop. The major components are adipose tissue and vessels. The exact functions are not understood. Epiploic appendagitis (EA) is an inflammatory process, primarily may be due to torsion or vascular occlusion or may be secondarily related to other inflammatory processes. Symptoms vary from mild abdominal pain to severe variety, depending on the underlying cause. Primary EA is a benign self-limiting condition and does not require any surgical intervention, whereas secondary cause of inflammation needs management of underlying pathology. Proper diagnosis plays a vital role in appropriate management. Cross-sectional study like computed tomography (CT) is the ideal choice of imaging. On CT, epiploic appendigitis appears as round to oval fat-attenuating lesions with hyperattenuating peripheral rim, usually abutting the adjacent large bowel. Chronic inflammation shows peripheral calcification, may detach, and appears as intra-abdominal loose body. We describe three cases of secondary EA with CT imaging features, which will guide the clinician in proper management, avoiding unwarranted surgery or hospitalization.