To cut or not to cut: a case of epiploic appendagitis

A 47-year-old man presented to hospital with a 1 day history of acute left-sided abdominal pain. He was initially treated for renal colic but the pain continued to worsen. Surgical review elicited left iliac fossa tenderness with guarding. Observations were within normal limits but serology revealed a raised C reactive protein.

A provisional diagnosis of diverticulitis was made and abdominal CT was performed. CT revealed an area of circumferential density abutting the descending colon with central fat attenuation and stranding without corresponding colonic inflammatory change (figures 1 and 2). A diagnosis of epiploic appendagitis was made and the patient was subsequently discharged after a period of symptomatic treatment.

Epiploic appendagitis involves inflammation in the fatty appendix epiploica that line the colon and spare the rectum.1 They can become primarily inflamed due to torsion and vascular compromise or secondarily inflamed due to adjacent organ pathology.

Primary epiploic appendagitis has...

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