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Clinicopathological differences in attached versus loose infarcted epiploic appendages: an analysis of 52 cases
  1. Caroline Dignan1,
  2. Adya Senior1,
  3. Raul S Gonzalez2
  1. 1 Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
  2. 2 Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Raul S Gonzalez, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; rgonzal5{at}BIDMC.harvard.edu

Abstract

Background Epiploic appendages are fatty peritoneal structures on the external surface of the colon that can infarct and become necrotic in situ or autoamputate.

Aims To describe clinicopathological features of infarcted epiploic appendages (IEAs).

Methods We reviewed 52 IEAs from 49 patients, recording numerous clinical and pathological characteristics, which were compared across attached and loose IEAs.

Results Twenty-seven IEAs were attached, and 23 were loose; location was unclear in 2. Most were incidental; 3 attached cases caused ‘appendagitis’. Most (31, 60%) had a classic ‘egg-like’ appearance. Common findings included fat necrosis (84%), calcification (67%) and fibrosis (58%). Attached cases had a larger mean size (1.8 cm vs 1.3 cm, p=0.030) and were more often haemorrhagic (37% vs 4%, p=0.0064) and inflamed (67% vs 13%, p=0.0002). Loose cases were more often necrotic (100% vs 74%, p=0.011).

Conclusions IEAs have different morphology whether they remain attached to peritoneum or become necrotic and detached. Attached cases may cause symptoms.

  • gastrointestinal diseases
  • pathology
  • surgical
  • colon

https://doi.org/10.1136/jclinpath-2021-207411

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    Footnotes

    • Handling editor Runjan Chetty.

    • Contributors CD collected and analysed data and obtained photographs. AS collected data. RSG conceived the project, identified cases, analysed data and wrote the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.