Fat necrosis of the colon – a disease related to not eating enough fiber and being sedentary

Symptoms are similar to appendicitis, so it is easy to misdiagnose

44-year-old female patient, obese, right iliac fossa pain, no fever, abdominal pain, right iliac fossa unresponsive… Patient was examined at E Hospital and diagnosed appendicitis level, with indication for surgery˳

But when ultrasound, computed tomography detected inflammation of the colonic fatty mane, the appendix increased irritation but no inflammatory manifestations˳ The patient was transferred to medical treatment steatorrhea of ​​the colon˳

Another patient is a 24-year-old male with pelvic pain that requires hospitalization, accompanied by low-grade fever˳ Laboratory tests and ultrasonography both point to acute appendicitis˳ Laparoscopic examination of the abdomen showed a normal appendix, but a fatty mane of the caecum had black necrosis, the cecal wall was thickened, and there was fluid around˳

Doctor Bach Cong Hung, imaging department of Hospital E, said that colonic fatty mane is very similar to appendicitis and diverticulitis, so it is easy to be misdiagnosed˳

Appendicitis is a common disease in emergency departments, imaging has a clinical supporting role to help confirm and differentiate appendicitis from other diseases when the patient is diagnosed with appendicitis˳ stomach-ache right iliac fossa˳

“Fat mane of the colon is an inflammation that occurs in the fatty mane of the colon due to torsion or spontaneous occlusion of the veins draining this fatty mane˳ Most often in the Sigma colon, cecum, ascending colon; transverse colon + down (rare)˳

The disease usually occurs between the ages of 20 and 50, common in obese people˳ Ultrasound helps to orient, tomography has definite diagnostic value when the image is typical and helps in differential diagnosis with omental infarction, colonic diverticulitis, and appendicitis˳

Doctor Vu Ngoc Hoai, Department of Diagnostic Imaging, Lao Cai General Hospital, analyzed: Normally, there are about 100 fat manes along the colon˳ Finger-like shape, 2-5cm long, located along both sides of the intestinal wall˳ Normally, these fatty manes are not visible on CT and ultrasound˳ When torsion or thrombosis of the venous drainage of the fatty mane causes inflammation˳

Fatty mane of the colon accounts for 2-7% of patients with suspected diverticulitis and about 0˳3-1% of patients with appendicitis˳ Therefore, the disease is often misdiagnosed with these diseases˳

Most cases of colitis do not require surgery, medical treatment takes about 5-10 days˳ Patients who do not improve with conservative treatment or have worsening symptoms (high fever, increased pain, nausea and vomiting or inability to take oral food), recurrent disease or complications (intestinal obstruction, abscess, intussusception, intestinal adhesions…) required surgery˳

However, in fact, many patients with fatty meningitis have to have surgery because they are misdiagnosed with acute appendicitis because the clinical and subclinical symptoms are quite similar, so the patient was mistakenly operated on˳ not appendicitis but steatorrhea of ​​the colon˳

Benign but dangerous complications

The exact cause of steatorrhea has not been identified˳ Obesity and strenuous exercise are risk factors for fatty mane˳

Primary cause: The twisting of the colonic fatty mane leads to venous embolism or embolism causing ischemia˳ It causes blood vessels and arteries to supply blood to only a few specific locations, causing inflammation and the formation of abnormal fatty bands on the outside of the large intestine˳

Secondary causes: Usually occurs after colonic inflammation (diverticulitis, cholecystitis, appendicitis…) which changes the circulatory flow in the colon mucosa˳ This causes blood flow to be concentrated in a few locations, not evenly, so it stimulates an inflammatory response and is an opportunity for fat pockets to appear˳

Fatty colonitis is relatively benign, but in some cases complications can occur, such as:

– Intussusception

– Intestinal abscess

– Bowel obstruction

– Sticky intestines

– Peritonitis

– Adhesive wire condition

Colitis is a common disease of the colon, often associated with an inadequate fiber diet, lack of exercise, or difficulty in digestion˳

8-year-old child with severe multi-system inflammatory syndrome COVID-19, easily mistaken for appendicitis

TTO – An 8-year-old boy (Binh Chanh, HCMC) has severe multisystem inflammatory syndrome related to COVID-19 but has symptoms similar to acute appendicitis˳