Apendicitis epiploica en hernia postlaparotomía

We present the case of a 46-year-old woman, with morbid obesity and a history of bariatric surgery with biliopancreatic derivation, and good postoperative evolution. One year after surgery, she presented symptoms of right upper quadrant pain of some hours duration, accompanied by fever and leukocytosis. We performed an abdominal CT with IV contrast which showed clinical indications of acute cholecystitis, although no signs of gallbladder inflammation were observed on ultrasound examination. Tomographic study –figure 1 in axial (A) and sagittal plane (B)– showed an ovoid lesion with the low attenuation characteristic of fat, banded by a hyperdense halo in relation to a postlaparotomy peritoneal defect (arrowheads). The lesion was in the proximity of the hepatic flexure (asterisk). These CT findings are consistent with a diagnosis of epiploic appendicitis within an omental fat collection herniated by a surgical defect (or postlaparotomy hernia).