Epiploic Appendagitis in Three Young Men: CT Diagnosis, Clinical Mimics, and Conservative Management

Epiploic appendagitis (EA) is an uncommon, self-limiting inflammation of the small fat-filled sacs along the colon, occurring in approximately 0.3-1% of suspected appendicitis cases and 2-7% of suspected diverticulitis cases. EA can be primary (due to torsion or venous thrombosis) or secondary (associated with adjacent inflammatory conditions). We present a series of three male patients with primary EA, aged 25-37 years, who presented with sudden, localized abdominal pain variably involving the left lower quadrant, right lower quadrant, or flank. All were hemodynamically stable and afebrile; leukocyte counts and C-reactive protein were normal or only mildly elevated (C-reactive protein (CRP) up to 11 mg/L in two patients). Computed tomography (CT) scans revealed characteristic ovoid fat-density lesions with surrounding inflammatory stranding adjacent to the colon. Each patient was managed conservatively with paracetamol, fluids, and rest, avoiding unnecessary antibiotics, hospital admission, and surgery. Symptoms resolved within 7-10 days, with no recurrence at follow-up. These cases underscore the importance of recognizing EA to prevent overtreatment and highlight its variable presentation and favorable response to conservative management.