title: Perigastric appendagitis: CT and clinical features  in eight patients.
abstract: OBJECTIVE
  To describe perigastric appendagitis (PA) on CT as a new and distinct clinical entity to enable recognition and prevent additional unnecessary investigation or intervention.
  
  
  METHODS
  Institutional review board approval was obtained and informed consent was waived. Retrospective review of the clinical data and CT findings in eight patients with PA encountered over 10 years at one institution was performed. The English literature was reviewed and summarized. Two experienced abdominal radiologists reviewed the CT images by consensus.
  
  
  RESULTS
  Seven of eight patients had moderate to severe epigastric pain for 1–7 days. All eight patients (four men, four women; mean age 44 years, range 33–81 years) had no fever or leukocytosis. All underwent abdominal CT which showed ovoid fat inflammation along the course of the perigastric ligaments (gastrohepatic, gastrosplenic, and falciform). Two had gastric wall thickening. Although the inflammation was correctly described, the specific diagnosis was not made on initial interpretation in five patients. Subsequently, they underwent further diagnostic testing [an upper gastrointestinal examination and hepatobiliary iminodiacetic acid (HIDA) cholescintigraphy, an upper endoscopy and MRI examination, HIDA cholescintigraphy, another CT, and an MRI examination, respectively]. The HIDA cholescintigraphy, upper GI examination, and upper endoscopy examinations were normal. No repeated examination was performed on the other three patients. Pain resolved spontaneously in all within two days.
  
  
  CONCLUSIONS
  Perigastric appendagitis can present with an acute abdomen, which is safely managed conservatively if diagnosed correctly. Radiologists should be aware of the entity to avoid unnecessary intervention, and recognize the CT findings of ovoid fat inflammation in the distribution of the perigastric ligaments.
authors.forename: A I
authors.initials: AI
authors.lastname: Justaniah
authors.forename: F J
authors.initials: FJ
authors.lastname: Scholz
authors.forename: D S
authors.initials: DS
authors.lastname: Katz
authors.forename: C D
authors.initials: CD
authors.lastname: Scheirey
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000473:pathology; D034841:Abdominal Cavity / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007249:Inflammation / Q000000981:diagnostic imaging*; D008022:Ligaments / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014102:Torsion Abnormality / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D003287:Contrast Media