Epiploic appendagitis: the great simulator in acute abdominal pain

Natalia Tobajas-Ramos, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España
Ana Goñi-Navarro, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España
Andrea Senovilla-Ardid, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España
Ma. Beatriz Fernández-Lago, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España
Amalia Aranaz-Murillo, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España
Julián García-Maroto, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España

Epiploic appendagitis is an infrequent cause of acute abdominal pain, often mistaken for appendicitis, diverticulitis, or cholecystitis. It results from the torsion and ischemia of the colon’s epiploic appendages, leading to localized inflammation. Differential diagnosis is crucial, as its symptoms may overlap with other conditions. Appendicitis is associated with fever and leukocytosis, which are generally absent in epiploic appendagitis. Diverticulitis typically presents with colonic wall thickening on tomography, whereas epiploic appendagitis appears as an oval fat-density lesion with a hyperdense rim (ring sign) and an inflamed fatty center. Other conditions such as mesenteric lymphadenitis and omental epiploitis should also be considered. Treatment is conservative, based on anti-inflammatory drugs and analgesia, with resolution in 7-14 days. Proper identification prevents unnecessary surgeries and allows for appropriate management, highlighting the importance of imaging diagnosis in emergency settings.

Keywords: Epiploic appendagitis. Differential diagnosis. Computed tomography. Ultrasonography. Abdominal pain.