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Okay, so now we're going to talk about

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epiploic appendagitis, G-I-T-I-S.

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I have to say, when you dictate epiploic appendagitis,

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you have to check your spelling on the system.

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'Cause if it comes up as epiploic appendicitis

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and they get a surgical consult and a

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surgeon comes back to you, they're not happy.

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So always be careful of how you say this.

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So this is epiploic appendagitis.

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So what's an epiploic appendage?

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That's these fatty little

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globules that come off the colon

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you may remember from your days of gross

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anatomy, and when one of these fatty

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globules decides that it's going to turn

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in towards, it can result in fat necrosis.

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And fat necrosis is very painful.

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Standard appearance is just that it's

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centered on one side of the colon.

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You don't usually have as much inflammation

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on the other side of the colon.

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The fat is in the center of the inflammatory changes.

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There can even be a thrombosed vessel in the interior.

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We like to say that this treatment is just an NSAID.

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We like to say it's

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treat and street.

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It could be the favorite diagnosis of

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every ER doctor out there because it's

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an explanation for the patient's pain.

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It's only treated with NSAIDs and the patient can

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leave the ER, so it's very satisfying for all involved.

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Now we see them all around the colon,

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so they're not just on the left side.

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They're more prevalent on that side, just like

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we do see diverticulitis on other parts

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of the colon than just the sigmoid colon.

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We can see epiploic appendagitis.

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Here is a large epiploic appendagitis of the cecal region.

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I think the patient was suspected to have appendicitis,

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so this is a good reason why patients don't just

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go for an appendectomy without imaging because

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you wouldn't want to get an appendectomy in the

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setting of right-sided epiploic appendagitis. Again,

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there we go.

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The other differential is the omental infarct.

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We do see omental infarct.

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Those are infarcts of the omentum.

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They're kind of anterior, usually

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around the transverse colon.

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They're a bit larger as well

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than those epiploic appendage.

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So here's a fatty center of a large omental infarct.

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Usually the history by USMLE exams will be

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somebody who had a large meal or weightlifting,

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usually a younger population, and these just kind

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of happen when there's torsion of that omentum.

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And it, again, can come in with excruciating pain.

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The only treatment for these are

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symptomatic relief with NSAIDs, maybe,

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uh, a short-term, um, analgesic as well,

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and rest.

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There's no surgical intervention for these.

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They will sometimes go on to become calcified, but

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in general, it is completely conservative management.

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We like to say you can treat and street

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the patient and they should be just fine.

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So that's epiploic appendagitis on

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the spectrum of omental infarcts.