A hyperattenuating ring sign that represents the inflamed visceral peritoneal covering of the epiploic appendage and central dot sign that corresponds to engorged or thrombosed central vessels or central areas of hemorrhage or fibrosis are the two major CT features of EA (1).
EA is a rare and self-limited condition, mostly seen in middle-aged men, which is caused by either inflammation or ischemic changes related to torsion or venous infarction of the epiploic appendages (1).
Each epiploic appendage receives blood supply through the narrow stalk.
Epiploic appendages are small fat-filled, serosa-covered pedunculated structures on the external surface of the colon measuring 1 to 2 cm thick and 0.
The epiploic appendages vary in shape and size but usually measure about 3 cm long, each.
Epiploic appendages may sometimes calcify and detach becoming intraperitoneal loose bodies (8).
Epiploic appendage ligation and resection is rare and usually reserved for when conservative management fails or there is new or worsening symptoms such as fever, progressive pain, or refractory nausea and vomiting.
Epiploic appendagitis is typically a nonsurgical, self-limiting process resulting from torsion of one or more epiploic appendages along the sigmoid, descending, or right hemicolon with resultant vascular occlusion that leads to ischemia.
The most common etiologies of this entity are venous thrombosis (secondary) or torsion or incarceration of an epiploic appendage within a hernia sac (primary).
Epiploic appendages may become secondarily inflamed, complicating the diagnosis.
It consists of a thin, round, or oval high-attenuation ring representing thickened, inflamed visceral peritoneum surrounding the torsed epiploic appendage
are peritoneal pouches (composed of adipose tissue) arising from the serosal surface of the colon, being attached by a vascular stalk.