The appendix is involved in a diverse spectrum of inflammatory, infectious, benign, and malignant conditions that extend far beyond acute appendicitis. Although acute appendicitis remains the most common appendiceal emergency, numerous entities-including reactive appendiceal inflammation, inflammatory bowel disease, appendiceal endometriosis, mucinous and non-mucinous neoplasms, lymphoma, post-transplant lymphoproliferative disorder, and rare mesenchymal tumors-may present with similar clinical symptoms and overlapping imaging findings. Accurate distinction among these conditions is essential because management ranges from conservative medical therapy to appendectomy, right hemicolectomy, cytoreductive surgery or systemic oncologic treatment. Furthermore, several common mimics of appendiceal disease, including mesenteric adenitis, terminal ileitis, epiploic appendagitis, cecal diverticulitis, gynecologic disorders, and ureteric calculi, can closely resemble appendiceal pathology and may lead to inappropriate treatment if not correctly recognized. This narrative imaging review provides a comprehensive multimodality imaging approach to appendiceal diseases using ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and molecular imaging techniques. Emphasis is placed on imaging features that facilitate differential diagnosis, clinicopathologic and surgical correlation, recognition of disease mimics, assessment of complications, and determination of disease extent. The review highlights how radiologists contribute not only to diagnosis but also to treatment planning, surgical decision-making, staging, surveillance, and multidisciplinary patient management. Emerging applications of dual-energy CT, radiomics, artificial intelligence, and advanced molecular imaging are also discussed. By integrating imaging findings with clinical and pathologic considerations, this review aims to improve diagnostic accuracy, guide appropriate management, and strengthen the radiologist's role in the comprehensive evaluation of appendiceal pathology.

Torsion of an epiploic appendage (or epiploic appendagitis) is a rare condition that occurs mainly in adults between 20 and 50 years of age. The incidence of this pathology is relatively low and remains poorly documented due to its rarity and benign course. It accounts for approximately 2–7% of patients hospitalized for suspected appendicitis or sigmoid diverticulitis. We report a case of epiploic appendagitis and describe its clinical, radiological, and therapeutic features.

Aims: Acute diverticulitis (AD) and primary epiploic appendagitis (EA) are two distinct pathological entities that often present with similar clinical features, complicating the process of differential diagnosis. While AD is an inflammatory condition of the diverticula that may progress to significant complications, EA represents a self-limiting inflammatory process originating from ischemic infarction of an epiploic appendage. Accurate differentiation between these two conditions is crucial, as management strategies differ significantly: AD may require hospitalization and antibiotic therapy, while EA is typically managed conservatively. Laboratory parameters have been increasingly investigated to assist in the early and accurate diagnosis of these conditions. This study aims to evaluate the diagnostic value of routine laboratory parameters and to develop a novel scoring system to help clinicians distinguish between AD and EA. Methods: A retrospective analysis was conducted on 184 patients diagnosed with either EA or AD at Hitit University Medical Faculty Erol Olçok Training and Research Hospital between January 1, 2013, and January 1, 2022. Demographic data, laboratory values, including white blood cell count (WBC), neutrophil (NE), lymphocyte (LY), hemoglobin (Hb), platelet (Plt), mean platelet volume (MPV), albumin (Alb), creatine kinase (CK), and C-reactive protein (CRP), lesion localization, comorbidities, hospitalization status, length of stay, complications, interventions, recurrence, and colonoscopy findings were recorded. Comparative analyses between the EA and AD groups were performed. Multivariate analysis identified significant predictors for developing the Ramcho Index (RI) and the Ramcho Score (RS), which integrate laboratory and clinical parameters to create an objective, numeric index and a 0–9 point scale. Results: Among the 184 patients, 109 were diagnosed with AD and 75 with EA. CRP, neutrophil-lymphocyte ratio (NLR), and CRP-albumin ratio (CAR) were significantly elevated in AD (all p

Acute epiploic appendagitis (AEA) is a rare cause of acute abdomen due to ischemic inflammation of an epiploic appendage, often from torsion or venous thrombosis. We report the case of an elderly woman with acute left lower quadrant abdominal pain, initially suspected of having an abdominal abscess. Clinical examination showed localized tenderness without fever, with mild leukocytosis and elevated C-reactive protein. Ultrasound revealed an oval hyperechoic mass, confirmed by computed tomography (CT) as a hyperdense lesion with a central fatty core, consistent with AEA. Conservative management with non-steroidal anti-inflammatory drugs led to resolution within 7 days. The literature review highlights an incidence of 0.8-2.5% in acute abdomens, with a predilection for obese adults. Diagnosis relies on clinical and imaging findings, with CT as the gold standard. Differential diagnosis includes diverticulitis, appendicitis, and abscesses. An integrated clinical-instrumental approach is essential to avoid unnecessary surgical interventions.

Appendagitis, a rare cause of acute abdominal pain, is an isolated inflammation of the omental appendix that often goes unrecognized. It is mainly diagnosed radiologically, thereby avoiding unnecessary surgery. We reported the case of a diabetic patient with appendagitis of the transverse colon, an exceptional location, which responded favorably to medical treatment.

Torsion of abdominal and pelvic organs, such as the spleen, gallbladder, omentum, epiploic appendages, fallopian tube, and epididymis/testicular appendix are relatively rare, and yet clinically significant, often imitating more common causes of acute pain. Given the nonspecific presentation and limited value of laboratory tests, imaging drives early recognition and timely, organ-preserving management. This review consolidates pathophysiology, modality-specific appearances, and practical diagnostic strategies for uncommon non-intestinal torsions. The unifying mechanism is rotation around a mesenteric or vascular stalk that first impedes venous outflow, then compromises arterial supply, culminating in edema, ischemia, and possible infarction. Predisposing conditions include congenital ligamentous or mesenteric insufficiency and acquired factors such as trauma, pregnancy, mass effect, and age-related laxity. Ultrasound may demonstrate organ enlargement, asymmetric morphology of paired organs, and, when captured, the twisted pedicle ('whirlpool' sign). Doppler findings may support the diagnosis but preserved arterial signals do not exclude torsion. CT allows clearest delineation of organ displacement, pedicle twisting, hypoenhancement, and inflammatory fat stranding. CT is especially helpful in diagnosing splenic and gallbladder torsion and in distinguishing omental torsion from epiploic appendagitis. MRI, as a radiation-sparing alternative, reliably depicts early ischemic change and variations of pelvic anatomy. Management varies from conservative therapy for epiploic appendage torsion to urgent detorsion or definitive resection for splenic, biliary and gonadal torsions. Familiarity with cross-sectional hallmarks, modality-appropriate workflows can shorten time to intervention and enhance organ salvage and outcomes.

Epiploic appendagitis (EA) is an underrecognized cause of acute abdominal pain. While its localized inflammatory nature is well described, potential systemic inflammatory responses and underlying metabolic contributions remain poorly understood. This study aimed to investigate the association between EA and systemic inflammatory and metabolic markers—Triglyceride-Glucose (TyG) index, Systemic Immune-Inflammation Index (SII), and Systemic Inflammation Response Index (SIRI). In this retrospective case–control study, we evaluated 85 patients with CT-confirmed EA and 79 age- and sex-matched controls. Biomarker data (TyG, SII, SIRI) were obtained from routine laboratory tests. Inflammatory severity and lesion volume were assessed via CT. Comparative, correlation, and logistic regression analyses were conducted. The TyG index did not significantly differ between EA and control groups (p = 0.354). However, both SII and SIRI were significantly elevated in EA patients (p < 0.001 for both). The strongest predictor of EA was log-transformed SII (OR = 3.85; 95% CI: 1.35–11.0), followed by SIRI (OR = 2.94; 95% CI: 1.25–6.91). While no significant correlation was found between biomarker levels and lesion volume, SII and SIRI values showed an increasing trend with radiological severity, though not statistically significant. Although CRP was a significant univariate predictor, our focus remained on novel indices (SII/SIRI) for their clinical applicability. SII and SIRI may serve as useful, readily available and inexpensive biomarkers to support the diagnosis and monitoring of EA, particularly in diagnostically challenging cases. Although the TyG index did not reach statistical significance, future studies with larger, prospectively collected cohorts excluding confounding metabolic conditions are warranted to further explore its role. Overall, systemic inflammatory indices could enhance understanding of EA’s pathophysiology beyond localized inflammation.

Internal hernias are a rare cause of small-bowel obstruction (SBO), particularly in patients without prior abdominal surgery. This case report describes a 70-year-old male presenting with acute intestinal obstruction in a virgin abdomen. Initial imaging suggested SBO but failed to identify a clear transition point. Diagnostic laparoscopy revealed a rare internal hernia caused by a ring formed by the inflamed epiploic appendages of the sigmoid colon. The entrapped bowel was successfully released, and histopathological examination confirmed epiploic appendagitis. This case highlights the diagnostic challenges of SBO due to internal hernias and underscores the importance of surgical exploration in unclear cases. Early identification and intervention are crucial to prevent complications such as bowel ischaemia. This report contributes to the limited literature on epiploic appendage-induced internal hernias, emphasising the need for multidisciplinary collaboration in managing rare abdominal pathologies.

BACKGROUNDEpiploic appendagitis is a rare, often underrecognized cause of acute abdominal pain. Misdiagnosis can lead to unnecessary hospitalization, antibiotic use, or surgical intervention. Advances in imaging have improved the recognition of this self-limiting condition, but clinical awareness remains critical.AIMTo provide a comprehensive update on the epidemiology, anatomy, pathogenesis, clinical presentation, diagnostic strategies, differential diagnosis, and management of epiploic appendagitis, emphasizing its distinguishing features from other causes of acute abdomen.METHODSA review of the literature was conducted, focusing on the clinical characteristics, imaging findings, differential diagnoses, and evidence-based management strategies for epiploic appendagitis.RESULTSEpiploic appendagitis typically presents with acute, localized, non-radiating abdominal pain without significant systemic symptoms. Diagnosis is heavily reliant on imaging, with computed tomography (CT) being the gold standard. Hallmark CT findings include a small, fat-density ovoid lesion adjacent to the colon, with the usual characteristic ring and dot signs. Differential diagnoses include mainly diverticulitis, appendicitis, omental infarction, and many other causes. Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation, reserving surgical intervention for rare, complicated cases.CONCLUSIONRecognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions. Increased clinician awareness, coupled with judicious use of imaging, facilitates timely diagnosis and appropriate management, ensuring optimal patient outcomes.

Omental infarction and epiploic appendagitis are rare conditions characterized by fat tissue necrosis and clinically presenting with acute abdominal pain. Omental infarction and epiploic appendagitis can mimic various acute urological, surgical, and obstetric-gynecological diseases depending on pain localization. These conditions can be classified as primary or secondary, i.e. those of unknown origin or those resulting from a definite cause. It is generally believed that primary appendagitis is more common than primary omental infarction. Currently, there is no evidence-based consensus on the most optimal treatment approach for omental infarction and epiploic appendagitis. However, most experts agree that these conditions are self-limiting and tend to resolve spontaneously. Consequently, accurate detection and differentiation from other acute abdominal conditions requiring urgent surgery are crucial. For omental infarction and epiploic appendagitis, computed tomography remains the primary imaging modality in emergency diagnostics, as it is superior to clinical examination and blood chemistry in terms of sensitivity and specificity. The article reviews predisposing factors and anatomical prerequisites for primary omental infarction and epiploic appendagitis. It also details characteristic computed tomography signs that may be used to differentiate omental infarction and epiploic appendagitis between each other and from other acute abdominal conditions. Although computed tomography may identify typical signs of these conditions, the differentiation between primary omental infarction and epiploic appendagitis can sometimes be challenging. Therefore, the term “intra-abdominal focal fat infarction” is recommended.

Epiploic Appendagitis: A rare differential diagnosis of abdominal pain

Case RepoRtwith flavoxate.Laboratory tests were within normal limits, although a slight elevation of C-reactive protein was observed.Physical examination revealed a soft abdomen with pain on deep palpation and voluntary defense.Total abdominal ultrasound demonstrated an incidental finding of a hepatic hemangioma measuring 4.4 mm, biliary micropolyps (<2 mm), and a cyst in the right kidney measuring 12 mm in diameter.In the right flank and iliac fossa, an echogenic image with a hypoechoic area inside, painful on examination, measuring 17 12 mm, was observed.The appendix was not increased in size, ruling out appendicitis. Case 1A 46-year-old female patient was admitted to the emergency department with colicky abdominal pain in the periumbilical region, nausea, vomiting, dyspepsia, and chills.Her only significant surgical history included appendectomy, exploratory laparotomy, and cesarean section.Administration of analgesics and antispasmodics did not improve her symptoms.On physical examination, she presented with increased peristalsis, pain in the left iliac fossa, and abdominal resistance.Laboratory tests were within normal limits.Abdominal computed tomography (CT) suggested a possible diagnosis of appendagitis vs omental infarction (Fig. 1).A total abdominal ultrasound revealed an epiploic appendix with inflammatory signs.The patient was discharged with an antibiotic (moxifloxacin), an antispasmodic, and follow-up.In the left iliac fossa, in contact with the anterior wall of the junction between the descending colon and the sigmoid colon, heterogeneous paracolic fat with increased density and linear striation, measuring 36 25 mm, appeared inflammatory (Fig. 1).The findings suggest a focal inflammatory process in the anterior paracolic fat at the junction between the descending colon and the sigmoid colon, indicative of omental infarction vs appendagitis.

I appreciate the opportunity to comment on the article “Woman with Right Abdominal Pain” by Ku et al., recently published in the Hong Kong Journal of Emergency Medicine.1 The authors effectively illustrate how point-of-care ultrasonography (POCUS) can accurately identify epiploic appendagitis, distinguishing it from more common conditions such as appendicitis and diverticulitis. This study highlights the significance of POCUS as a noninvasive diagnostic tool that enhances clinical decision-making in emergency medicine. Previous research has demonstrated that POCUS has a sensitivity of 92.3% and a specificity of 100% in diagnosing epiploic appendagitis.2 The findings presented reinforce its utility in differentiating benign intra-abdominal conditions from surgical emergencies, ultimately helping to prevent unnecessary medical interventions. Beyond this important study, I would like to highlight several related aspects of POCUS and initiate further discussion. Standardized training protocols alongside competency assessments remain essential for improving POCUS diagnostic accuracy. Ku et al. correctly pointed out the operator-dependent nature of this diagnostic method.1 Research demonstrates that experienced practitioners achieve better diagnostic accuracy through POCUS.3 Therefore, structured training programs should be implemented to ensure reliability and consistency in POCUS-based diagnoses. Although POCUS serves as a valuable initial diagnostic tool, advanced imaging methods still play a crucial role in certain cases. Contrast-enhanced computed tomography (CT) remains the gold standard for a definitive diagnosis in patients with atypical presentations or coexisting conditions.4 Literature suggests that combining POCUS with CT improves diagnostic accuracy, preventing misdiagnoses and ensuring appropriate patient management.5 POCUS is a key tool in the emergency department, allowing for rapid and precise diagnoses. However, its widespread adoption in a resource-limited area requires further research into cost-effectiveness as well as initiatives to improve accessibility to ultrasound equipment.6 Expanding POCUS training and availability could significantly enhance emergency care in underserved regions. Ku et al.'s case study demonstrates the value of POCUS in emergency medicine. Future studies should explore its application in diagnosing other uncommon causes of acute abdominal pain. Additionally, research should examine not only its diagnostic accuracy but also its potential therapeutic benefits. The authors deserve praise for their insightful case-based analysis, which reinforces the relevance of POCUS in modern emergency medical practice. Their study provides valuable information for clinicians striving to improve patient outcomes through evidence-based approaches. The author declares no conflicts of interest. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1002/hkj2.70005. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Subacute epiploic appendagitis (SEA) is a rare inflammatory condition involving the epiploic appendages of the colon. It often presents with nonspecific abdominal symptoms and can mimic various gastrointestinal disorders, leading to diagnostic challenges. Here, we present a case of a 74-year-old female who initially presented with left-sided abdominal pain and incomplete stool emptying, raising suspicion for other conditions such as cathartic colon. However, imaging studies revealed characteristic findings suggestive of SEA, highlighting the importance of considering this rare entity in the differential diagnosis of abdominal pain.

Epiploic appendagitis is a rare condition in which there is inflammation of the appendices epiploicae (AE). It is rare to see small bowel obstruction due to herniation of the small intestine through adhesion between two adjacent AEs forming a loop. We, herein, present the case of a 64-year old male patient who had presented to us with acute small bowel obstruction. During laparoscopy, the culprit was found to be an internal herniation of an ileal loop between the two AE of the sigmoid colon, which were adherent at their tips. Laparoscopic transection of the tourniquet and excision of the AE was performed, and the patient had an uneventful postoperative recovery.

Abstract Objective The objective of this study was to assess the role of point‐of‐care ultrasonography (POCUS) in the diagnosis of epiploic appendagitis, a relatively rare but important cause of right lower quadrant (RLQ) abdominal pain, in an emergency department setting. We aimed to evaluate the utility of POCUS in differentiating epiploic appendagitis from other acute abdominal conditions such as appendicitis and diverticulitis. Method This was a case‐based study in which a 51‐year‐old female patient presented with a 3‐day history of RLQ abdominal pain. Initial clinical examination showed RLQ tenderness with rebound tenderness. POCUS was performed at the bedside, followed by contrast‐enhanced computed tomography (CT) for definitive diagnosis. The findings on POCUS were compared with CT imaging to evaluate the diagnostic accuracy of ultrasound. Result POCUS revealed a thickened ascending colon hyperechoic mass, adherent to the colon, which lacked the acoustic shadowing or blind‐ended tubular structure typically seen in appendicitis. These findings were consistent with epiploic appendagitis. The final diagnosis was confirmed by CT imaging, which demonstrated a hyperattenuating ring with surrounding fat stranding and mild colon wall thickening, consistent with epiploic appendagitis. POCUS showed a high sensitivity (92.3%) and specificity (100%) for diagnosing this condition. Conclusion POCUS is a valuable diagnostic tool in the emergency department for identifying epiploic appendagitis, particularly in patients with non‐specific abdominal pain. It can help avoid unnecessary surgical interventions and hospital admissions when properly utilised. While CT remains the gold standard for diagnosis, POCUS offers a rapid, non‐invasive and cost‐effective alternative in acute settings. Further research is recommended to evaluate the broader application of POCUS for epiploic appendagitis in varied clinical scenarios.

Epiploic appendagitis (EA) is a rare and self-limiting cause of acute abdominal pain resulting from ischemia due to torsion or venous thrombosis of epiploic appendages. It often mimics more common conditions, such as diverticulitis or appendicitis, leading to misdiagnosis and unnecessary interventions. While EA is typically idiopathic, we present a unique case of trauma-induced EA in a 58-year-old man who developed sharp left lower quadrant pain after prolonged abdominal pressure while repairing a boat engine managed conservatively, which, to our knowledge, has not been previously reported. With the increasing availability of computed tomography (CT), EA is being diagnosed more frequently, yet clear management guidelines remain lacking.

Epiploic appendages are fat-filled outpouchings arising from the serosal surface of the colon and have uncertain physiological functions. Epiploic appendagitis is characterized by inflammation of these appendages. Primary appendagitis often results from ischemic injury, while secondary appendagitis may arise from the contiguous spread of inflammation or infection from adjacent structures. Clinical features of epiploic appendagitis include acute or subacute abdominal pain, most commonly in the lower quadrants, without significant concurrent constitutional or other gastrointestinal symptoms. Diagnosis relies on imaging modalities, with Computed Tomography (CT) being the preferred method. Management of epiploic appendagitis is mainly conservative, with analgesic and anti-inflammatory agents being the mainstay of treatment. Surgical indications are poorly defined, but laparoscopic excision of the inflamed appendage may be considered in cases of recurrent or refractory symptoms. This review article explores the anatomy, pathophysiology, clinical features, diagnosis, and management of epiploic appendages and appendagitis. Keywords: Acute Abdomen, appendagitis, epiploic Appendages

Introduction Acute epiploic appendagitis is an uncommon and easily misdiagnosed cause of acute abdominal pain. The diagnosis of epiploic appendagitis has clear clinical importance in patient management. In the case of acute abdominal pain, Radiology plays a critical role in the diagnosis of this condition, which often mimics other conditions that require surgical intervention. The aim of this article is to evaluate the frequency and presentation of acute epiploic appendicitis in our patient population and to remind them of this pathology. Materials and Methods Adult patients applied to the emergency department with acute abdominal pain and were evaluated with abdominal computed tomography (CT) between January 2022 and December 2022 were retrospectively analyzed. Patients were grouped according to the common causes of acute abdomen. The frequency and common presentation of epiploic appendagitis were researched. Results In the 1-year retrospective radiology database search, CT findings were consistent with epiploic appendicitis in 8 of 256 patients. The anamnesis, physical examination, and laboratory findings of these 8 patients were examined retrospectively. Conclusion Epiploic appendagitis is a rare but self-limiting cause of acute abdomen. In the management of acute abdominal pain, emergency physicians and radiologists should also remember this clinical situation in order to avoid unnecessary surgical interventions.

Background: Epiploic appendagitis is a rare cause of acute abdominal pain due to ischemia or inflammation of the epiploic appendages, small fat filled structures along the colon. Because of its clinical presentation often mimicking more common conditions such as appendicitis or diverticulitis, it can be a diagnostic challenge. The appendix is equally uncommon in a subhepatic location, and this atypical location adds further to the diagnostic difficulty. Early recognition and treatment are important to prevent complications and to ensure effective treatment. Case Presentation: A non-hypertensive, non-diabetic male presented with a 3-day history of continuous right upper quadrant pain, accompanied by nausea and vomiting. Physical examination revealed right upper quadrant tenderness with rebound tenderness, while laboratory tests showed elevated inflammatory markers. Ultrasound findings included a non-compressible, edematous blind loop in the subhepatic region measuring 9.2 mm in diameter. It is surrounded by stranded mesenteric fat, echogenic mesocolic fat, colonic wall edema, and a minimal free fluid collection. Based on these findings, subhepatic acute appendicitis with associated acute epiploic appendagitis was diagnosed. The patient underwent emergency laparoscopic appendectomy and removal of the inflamed epiploic appendages. Intraoperative findings confirmed a suppurative appendix in the subhepatic region and thickened epiploic appendages surrounded by inflamed tissue. Histopathological analysis corroborated features of subhepatic appendicitis and epiploic appendagitis. Conclusion: The diagnostic and surgical complexities of subhepatic appendicitis and epiploic appendagitis are illustrated in this case. Laparoscopic surgery remains a safe and effective treatment and imaging is important in identifying atypical presentations. Management of atypical acute abdominal pain presentations requires awareness of these conditions.