Case Presentation:

A 54 years old female with past medical history of hypertension, frequent UTIs, and
hypothyroidism presented with 3 days of sharp LUQ abdominal radiating to the left flank, 8/10
in severity and worsened with eating. On admission, temperature was 36.2 °C, pulse rate 78
beats/min, respiratory rate 20/min and blood pressure 134/87. On physical examination the
abdomen was soft with remarkable localized tenderness over the left upper quadrant and the
epigastric area.
Laboratory studies showed no leukocytosis. Liver and renal function tests were within normal
limits. Abdominal roentgenogram did not show pneumoperitoneum or bowel obstruction. CT
of the abdomen and pelvis showed a focal area of fat stranding surrounding the mid
descending colon compatible with epiploic appendagitis and normal appendix. She was
admitted for overnight observation and treated nonoperatively with analgesia, intravenous
fluids and bowel rest. Patient did not require surgical intervention and was discharged after
her pain was subsequently improved.


Epiploic appendages are small pedunculated fatty structures covered by peritoneum
distributed along two rows at the surface of the colon. They are more numerous at the level of
the sigmoid colon and ceacum. Primary epiploic appendagitis is an uncommon cause of
abdominal pain that occurs either from appendageal torsion or spontaneous thrombosis of an
appendageal draining vein.
The sigmoid colon is the most frequent site of this disorder. Depending on its location, epiploic
appendagitis may mimic nearly any acute abdominal conditions as cholecystitis, appendicitis
or nephrolithiasis.
The clinical findings are nonspecific, leading to frequent misdiagnosis. On the other
hand, The disorder can be recognized ultrasonographically by the presence of small
hyperechoic and hypoechoic structures next to the colon wall, in addition to slightly enlarged
mesenteric lymph nodes. There may also be an absence of vascularity on color Doppler
ultrasonography. Ultrasonography can establish the diagnosis, although computed
tomography is more commonly used.


Torsion or inflammation of the appendages epiploicae is a rare cause of acute abdominal
pain. High index of suspicion is needed to direct investigation especially in non­clear cut
diagnosis. Epiploic appendagitis should be suspected in the setting of sudden onset
abdominal pain, the use of imaging study is important for diagnosis of epiploic appendages,
and when diagnosed preoperatively, conservative treatment is safe as the condition is
self­limiting and close follow­up with CT imaging is required.
Prompt diagnoses decrease chances of morbidity and mortality associated with invasive
interventions and prolonged hospitalization.