Colon
Other nonneoplastic
Infarcted epiploic appendages


Topic Completed: 3 March 2021

Minor changes: 10 March 2021

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PubMed Search: Infarcted epiploic appendages

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Infarcted epiploic appendages. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/coloninfarcted.html. Accessed July 24th, 2021.
Definition / general
  • Infarction and subsequent fat necrosis of epiploic appendages (fat containing pouches of colonic peritoneum) that may remain attached or autoamputate and lie loose in the peritoneum
Essential features
  • Fat necrosis of epiploic appendage, which may detach and lie loose in the peritoneum
  • May cause pain or be discovered as an incidental curiosity
Terminology
  • Epiploic appendagitis: inflammation but not infarction of appendages
  • Unattached infarcted appendages are known as peritoneal loose bodies or peritoneal mice (J Clin Gastroenterol 2006;40:427)
Sites
  • Epiploic appendages are chiefly on transverse and sigmoid colon
  • Can occur on appendix (S D Med 2006;59:511)
Etiology
Clinical features
Diagnosis
  • Laparoscopy
Radiology description
Radiology images

Images hosted on other servers:

Central calcified oval mass in the pelvis

Pelvic mass

Case reports
Gross description
  • Firm, gray-white nodules that may resemble metastatic tumor
  • Loose bodies can resemble an egg
Gross images

Images hosted on other servers:

Egg shaped mass

Giant loose peritoneal body

Giant loose body attached to omentum

Round pelvic mass

Central calcifications and a distinct fat plane

Macrograph of giant loose body

Microscopic (histologic) description
  • Central infarcted adipose tissue with peripheral fat necrosis and calcification, surrounded by thick, inflamed fibrotic tissue
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Rounded contour

Central fat necrosis

Circumferential fibrous tissue

Sample pathology report
  • Abdominal cavity, loose body, removal:
    • Fat necrosis with fibrotic rim, consistent with infarcted epiploic appendage
Differential diagnosis
  • Fat necrosis from other cause:
    • Not rounded / encapsulated or free floating, may show more inflammation
Board review style question #1
Infarcted epiploic appendages Infarcted epiploic appendages


A loose egg-like object is found in a patient's abdomen during planned abdominal surgery. It has a microscopic appearance as shown above. What is the best diagnosis?

  1. Calcifying fibrous pseudotumor
  2. Fecal material
  3. Infarcted epiploic appendage
  4. Well differentiated liposarcoma
Board review style answer #1
C. Infarcted epiploic appendage

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