A 46-year-old man presented with left lower quadrant pain, tenderness, and rebound tenderness on examination. He was afebrile and did not have leucocytosis. The abdominal CT showed a hypodense pericolonic oval mass of 2·5 cm with adjacent fat stranding: a classic picture of epiploic appendagitis

Epiploic appendages are roughly 50—100 pedunculated adipose structures protruding from the serosal surface of the colon from the caecum to the rectosigmoid junction. Torsion of the pedicle or central venous thrombosis could cause epiploic appendagitis, which can simulate diverticulitis, appendicitis, and cholecystitis. Fever, chills, and leucocytosis are usually absent. In addition to the CT indicating this diagnosis, a non-compressible hyperechoic mass connected to the adjacent colon at the point of maximum tenderness on ultrasonography is indicative of epiploic appendages. Epiploic appendagitis needs only conservative management and pain control; however, failure to recognise this diagnosis could lead to unnecessary intervention.

Source: Lancet