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Special Feature
June 15, 2009

Image of the Month—Diagnosis

Arch Surg. 2009;144(6):587-588. doi:10.1001/archsurg.2009.62-b

After the dark mass was detached from the parietal peritoneum, a strangulated omental appendix became apparent and was constrained by 2 additional flanking appendices. After applying a loop to the neck of the appendix, it was removed. Pathological review of the specimen revealed fat necrosis and inflammatory cells within the omental appendix. The clinical course was uneventful, and the patient was discharged after 48 hours.

Omental appendices (also known as epiploic appendicesor epiploic appendages) are peritoneal pouches that arise from the serosal surface of the colon. Composed of adipose tissue and blood vessels, they have an average length of 3 cm. Those next to the sigmoid colon are the largest. The term epiploic appendagitiswas introduced in 1956 by Dockerty et al1to describe inflammation of these appendices. The main cause for inflammation and symptoms is torsion and/or strangulation of the appendages.2