[醫學]epiploic appendigitis－銅筋鐵肋的秘密基地

Woman with acute abdominal pain.
What's the lesion and what's the diagnosis?

==>Differential Diagnosis:

Acute omental torsion/infarct
Acute diverticulitis
Acute epiploic appendagitis
Sclerosing mesenteritis

==>Acute epiploic appendigitis:
- Epidemiology: most seen in 4th-5th dacade male
- Clinical symptoms: LLQ pain (sigmoid colon site)
- Pathophysiology:
    *epiploic appendage (especiallt sigmoid area, which has larger appendage) ischemia.
    *2 arterial supply and only 1 venous drainage. Venous occlusion is most seen.
    *torsion of appendage stalk-->compromise of vascular supply-->ischemia of fatty tissue
     *local pain or peritoneal sign (induce peritonitis)
- Diagnosis:
    *CT showed pericolic oval-shaped pedunculated mass, 1-4 cm in diameter,
            with fat attenuation (approximately 60 HU).
    *Echo showed a hyperechoic ovoid mass with hypoechoic margin
- Tx: Abx use