Epiploic appendicitis

A 50-year-old woman presented with sudden onset of localised pain in the right and later the left lower abdomen, without other complaints. Only tenderness in the left lower abdomen was noted at physical examination. The ESR (25 mm/1st hr) and C-reactive protein (25 mg/l) were slightly elevated. The ultrasound (US) revealed a solid ovoid non-compressible hyperechoic mass (diameter 26 mm) at the point of maximum tenderness. The CT scan confirmed the presence of this lesion which appeared to be an infarction of an epiploic appendix with subsequent inflammation, called primary epiploic appendagitis. On conservative therapy the pain resolved in four weeks. The follow-up US and CT showed disappearance of the lesion after 35 days. When epiploic appendagitis is suspected, an US followed by CT is helpful to confirm the diagnosis and to avoid unnecessary treatment with antibiotics or operation.