Primary epiploic appendagitis: CT diagnosis for conservative management

OBJECTIVE: Primary epiploic appendagitis is an uncommon, self-limited disea se with spontaneous resolution. Diagnosis is usually made at surgery as the disease is generally mistaken for acute appendicitis or sigmoid diverticul itis. CT allows a non-invasive diagnosis, thus avoiding unnecessary surgery . The condition can be managed conservatively with the use of analgesic dru gs only, and clinical evolution is uneventful. The aim of this study is to report the CT features of this pathologic process before and after medical treatment by analgesics. PATIENTS AND METHOD: Six patients (4 men and 2 women aged from 23 to 70 yea r old mean; 29 year old) underwent abdominal CT scan because of acute abdom inal pain located in the left lower quadrant (n = 3) and right lower quadra nt (n = 3). No patient had fever. Laboratory findings were normal in all ca ses. Follow-up CT scans were obtained in 4 patients respectively at 2, 4, 8 and 80 weeks. RESULTS: CT scan showed in all cases a fatty mass located to the anterolate ral wall of the colon, delineated by an hyper attenuating rim. Infiltration of the pericolic fat was noted in all cases. Follow up CT scans obtained i n 4 patients showed that the inflammatory signs had cleared in ail cases, t he lesion had disappeared (n = 2), decreased in size (n = 1) or a residual paracolic node was observed (n = 1). CONCLUSION: Primary epiploic appendagitis is a rare disease. Knowledge of C T signs allowed the correct diagnosis and a conservative management.