Primary Epiploic Appendagitis

A previously healthy 27-year-old man presented to the emergency department with a three-day history of left lower quadrant pain. He denied fever, nausea, vomiting, or diarrhea. Vital signs were unremarkable, and physical examination revealed tenderness in the left iliac fossa without peritoneal signs. His leukocyte count and C-reactive protein were slightly elevated. On abdominal computed tomography (CT) (Figure), a fatty ovoid mass abutting sigmoid colon demonstrated the infarcted or inflamed appendix epiploica. A surrounding hyperdense rim (hyperattenuating ring sign) represented the inflamed visceral peritoneal covering, and the central linear hyperdensity corresponded to the thrombosed central vessel.1 The patient was treated with pain control and intravenous hydration, and was discharged uneventfully five days later.

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