GI Radiography


Case 21 :
Patient presents with acute abdominal pain. USG is normal. CT is performed.
What is the diagnosis?
Click here for bigger picture
Click here for bigger picture
Click here for bigger picture
Fig.1
Fig.2
Fig.3
________SCROLL FOR ANSWER__________





Diagnosis:

Primary epiploic appendagitis

Discussion:

Appendices epiploicae, first described by Vesalius in 1543, are small pouches of peritoneum, about 3 cm in length that contain pericolic fat and are most common in the sigmoid and caecum. They number approximately 100 and are found in two rows attached to the teniae coli. The appendices epiploica are thought to have a protective function against intraabdominal infections. It is estimated that the appendages with a narrow base predispose to torsion resulting in thrombosis of the nutrient vessels, with secondary infarction, hematoma, inflammation, and pericolic abscess formation. Spontaneous resolution of the inflammation is thought to give rise to fibrous or calcified peritoneal loose bodies first described by Littre in 1703.


CT Findings

On CT, the diagnosis of inflammation of the appendices epiploicae should be suspected when there is focal localized inflammatory changes in the pericolonic fat.(1)However, this finding is very nonspecific and the distinction of this entity from diverticulitis may not be possible with CT. Rarely, a central high-attenuation "dot" can be identified within the inflamed appendage; this finding corresponds to the thrombosed vein.

Dr. Bhujang Pai, Hinduja Hospital, Mumbai