The answer is - Acute epiploic appendagitis
This is inflammation of the epiploic appendages (fat outpouching on the serosal surface of the colon). This is likely secondary to torsion or venous obstruction in this fat outpouching.
It has a nonspecific presentation. Commonly has focal tenderness (usually lower abdomen/pelvis). The most common presentation is focal left lower quadrant pain. It is most commonly in the sigmoid followed by descending, cecum and then the ascending. Commonly misdiagnosed as diverticulitis or appendicitis. Often in 4th-5th decade and usually male. Risk factors - obesity, hernia and "unaccostomed exercise".
Typical imaging appearance - CT - fatty process adjacent to the colon (commonly 1-3 cm but can be as big as 5 cm) with enhancing rim and adjacent inflammatory changes. It often has a dense center that represents the occluded central vein (about 54% of the time) - aka central dot sign.
US - oval noncompressible hyperechoic focus adjacent to colon at site of maximum tenderness with no central flow on color doppler.
MRI - T1 and T2 show lesion that looks like fat that has a peripherally enhancing rim on postcon T1 fat sat.
Evolution - images obtained at 6 months or greater show total resolution.
Treatment - conservative with pain medications.
Complications - RARE - adhesions, bowel obstruction, intussusception, intraperitoneal loose body (does that mean the appendage falls off and calcifies as loose body in the abdomen? - not clear from reference) and abscess formation.
DDX - Omental infarcts, sclerosing mesenteritis, acute diverticulitis, fatty masses in peritoneum
references - http://www.ajronline.org/cgi/content/full/183/5/1303 ; http://radiographics.rsnajnls.org/cgi/content/full/25/6/1521 - Notice that the primary author is same guy
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