Perigastric appendagitis: CT and clinical features in eight patients

Surgical admission secondary to perigastric appendagitis: an uncommon cause of acute epigastric pain

A patient in her late 20s presented with severe epigastric pain. A CT scan of the abdomen and pelvis was performed to exclude an upper gastrointestinal perforation. This showed findings of perigastric appendagitis. This is a rare cause of severe upper abdominal pain. The patient was treated with oral and intravenous analgesia medication and discharged the next day. No surgical intervention was required.

Peri-gastric appendagitis with lesser omentum hemorrhagic infarction: US, CT, and MRI findings of a rare entity

Peri-gastric appendagitis followed associated with gastro-hepatic ligament/lesser omentum hemorrhagic infarction has not been well investigated yet. With an accurate radiological diagnosis of peri-gastric appendagitis, even in case of hemorrhagic infarction, the patient can receive supportive measures for the self-limited pain and can forgo surgery, endoscopy, and further invasive testing.

Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings

Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.

Imaging findings of diseases affecting the gastrohepatic ligament: not as acquiscent as it seems

The gastrohepatic ligament, a major part of the lesser omentum with hepatoduodenal ligament, is an important anatomic structure connected to several other intraabdominal organs and ligaments. It is at the crossroads of several different anatomic structures and may be affected by different diseases. In this article, we aim to increase the awareness of imagers to this small anatomic structure and provide clues for correct diagnosis and assessment of diseases that may affect this area. We will examine various diseases involving the gastrohepatic ligament in detail and try to address its importance using representative cases.

Not Just Fat: Imaging in Abdominal Fat Pathology

Fat in abdomen has diverse distribution and function. Insult to fat due to several causes can result in infarction or necrosis and present as acute abdomen clinically. Intra-abdominal focal fat infarction is one such condition that comprises of epiploic appendagitis, perigastric appendagitis, omental infarction, and torsion of fatty appendage of falciform ligament that have characteristic imaging features. Secondary causes of fat necrosis include pancreatitis or trauma related. Metabolic or responsive fat changes, like hypertrophy and dystrophy, can be diagnosed on imaging especially on computed tomography. Mesentric fat stranding including the mesentric panniculitis spectrum poses diagnostic dilemma and the causes and imaging role are covered in this review. Some infections and neoplasms that preferably affect abdominal fat compartments may mimic benign conditions, although some have specific patterns of involvement.

Falciform ligament appendagitis after Roux-en-Y bypass surgery mimicking acute cholecystitis

Fatty falciform ligament appendage torsion (F-FLAT) is a rare type of intraperitoneal focal fat infarction that involves torsion of a fatty appendage of the falciform ligament. It may cause severe pain, mimicking an acute abdomen, but is typically self-limited and does not require hospitalisation or surgery. As a type of intraperitoneal focal fat infarction, it shares many of the same physiological, clinical and radiological features of epiploic appendagitis. To our knowledge, F-FLAT has not previously been reported in a patient following a laparoscopic Roux-en-Y gastric bypass surgery. Identifying falciform ligament appendagitis is critical because it can prevent unnecessary hospitalisation, follow-up studies and surgery.

Lesser omental panniculitis: a possible cause of acute abdomen

We encountered a case of panniculitis of the lesser omentum in 2018 after a long time since our first case report in 2007. We reviewed previously reported three cases of lesser omental panniculitis including our first case to investigate its clinical characteristics. Total four cases were relatively young with mean age of 30, and had common chief complaint of considerable epigastric pain and tenderness. Blood test showed increase in the white blood cell, C-reactive protein, or erythrocyte sedimentation rate. Computed tomography revealed mass like change in the fat tissue outside of the lesser curvature of the stomach. Histopathological diagnosis was made in one operated patient. Other three patients were treated conservatively, and progressed well. Lesser omental panniculitis is a possible cause of acute abdomen, which shows characteristic images of computed tomography and probably good progress by conservative treatment.

Unusual Cause of Epigastric Pain: Intra-Abdominal Focal Fat Infarction Involving Appendage of Falciform Ligament - Case Report and Review of Literature

Torsion of the fatty appendage of the falciform ligament, part of the spectrum of conditions known as intra-abdominal focal fat infarction (IFFI), is very rare with less than 20 cases reported on imaging so far. Here we report a case of torsion of the lipomatous appendage of the falciform ligament in a middle-aged female, diagnosed on ultrasound and computed tomography (CT). CT showed classical "hyperattenuating rim" sign in the anterior perihepatic space adjacent to the falciform ligament. We re-emphasize the importance of "hyperattenuating rim" sign on CT in recognizing IFFI in locations other than the pericolic region.