Epiploic Appendagitis

A 17-year-old healthy boy presented to the emergency department (ED) with acute, localized left upper quadrant constant abdominal pain, exacerbated by movements. He denied other symptoms. The physical examination was normal except rebound and point tenderness localized to the left upper quadrant of his abdomen. Laboratory studies, including inflammatory markers, were normal. His abdominal computed tomography (CT) findings were diagnostic of an epiploic appendagitis (Fig. 1).

FIGURE 1: Abdominal CT showing epiploic appendagitis on the left upper quadrant.

Epiploic appendagitis is a benign self-limiting condition caused by torsion of the small, fat-filled sacs or finger-like projections along the surface of the lower colon and rectum, the epiploic appendages. Pain described as sharp or stabbing is localized in the affected area; more often in the left lower than in the right lower quadrant ⁽¹⁾. Sometimes there is nausea and vomiting. The physical examination can mimic an acute abdomen ^(2,3) and can be misdiagnosed as appendicitis, cholecystitis, or diverticulitis. A lack of elevation in inflammatory markers or fever is suggestive of a more benign process ⁽⁴⁾. Despite its rare occurrence in children, epiploic appendagitis should be considered when evaluating abdominal pain. Abdominal CT findings include findings of an oval lesion with attenuation similar to that of fat, surrounded by a hyperattenuated ring, located near but distinct from the colon, often with periappendageal fat stranding in the absence of other diagnostic abnormalities ⁽⁵⁾. Early identification by imaging studies may prevent unnecessary surgical procedures. A well-looking child with this diagnosis can be discharged home with anti-inflammatory, analgesic treatment ⁽³⁾ and careful follow-up.