Presentation
Abdominal pain in the lower left quadrant for the last two weeks. No fever, diarrhoea, or emesis.
Patient Data
Contrast-enhanced abdominal CT shows some inflammatory stranding in the fatty tissue adjacent to the descendo-sigmoid junction, with demarcation of a small, fatty ovoid structure showing a hyperattenuating rim, representing an inflamed and/or ischaemic epiploic appendage. There is no diverticulitis, abscess, or perforation.
Incidental findings include sigmoid diverticula without acute inflammatory changes, an incidentaloma of the left adrenal gland, several liver haemangiomas, small renal cysts, and a small hiatus hernia.
Case Discussion
This patient presented with abdominal pain in the lower left quadrant for the last two weeks. He had no emesis, diarrhoea, or fever. The family physician suspected diverticulitis and referred him for CT imaging.
Findings on contrast-enhanced CT as detailed above are consistent with primary (spontaneous) epiploic appendagitis, a relatively rare inflammatory or ischaemic disorder of the fatty appendices epiploicae of the colon sometimes pathologically correlating with a focal fat infarction.
The most frequent differential are diverticulitis and acute appendicitis (if right-sided).
In this case, the patient was conservatively treated with a combination of NSAIDs and the symptoms resolved after another two weeks.
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