Epiploic appendagitis: 7-year experience and relationship with visceral obesity

Location, size, and local inflammatory findings in primary epiploic appendagitis (EA) have not been reported outside of small studies. The association between EA and increased adiposity is controversial. The goals of this project are to compare demographics and imaging-based measurements of adiposity between patients with EA and patients with acute abdomen without EA, and to identify CT features of EA.

A consecutive sample of acute, primary EA (n = 100), and control (acute abdomen; n = 100) was selected retrospectively. Cases of suspected EA were included if they had the characteristic ovoid fatty mass and hyperattenuated ring sign on CT. Abdominal adipose volume (AAV), visceral adipose area (VAA), and subcutaneous adipose area (SAA) were quantified by CT. Location, size, and frequency of coexisting local inflammatory findings in EA patients were recorded.

EA had 60% greater AAV, 117% greater VAA, and 35% greater SAA than control subjects (p < 0.0001). Males composed a great proportion of the EA group (67%) than the control group (41%) (p = 0.0002). Inflamed appendage was found in sigmoid colon in 49% of cases, descending colon in 23%, and right colon in 19%. Peritoneal thickening was frequent (76%) and bowel wall thickening was common (47%). Diverticulosis coexisted incidentally in 28%.

EA is associated with increased abdominal adipose tissue. EA can occur in both sexes at any age, but occurs at age 50 on average and more frequently in males. Patient with EA exhibited central hyperdense dot (79%), peritoneal thickening (76%), and bowel wall thickening (47%).