Fat stranding adjacent to thickened bowel wall seen at computed tomography (CT) in patients with acute abdominal pain suggests an acute process of the gastrointestinal tract, but the differential diagnosis is wide. The authors observed "disproportionate" fat stranding (ie, stranding more severe than expected for the degree of bowel wall thickening present) and explored how this finding suggests a narrower differential diagnosis, one that is centered in the mesentery: diverticulitis, epiploic appendagitis, omental infarction, and appendicitis. The characteristic CT findings (in addition to fat stranding) of each of these entities often lead to a final diagnosis. Diverticulitis manifests with mild, smooth bowel wall thickening and no lymphadenopathy. Epiploic appendagitis manifests with central areas of high attenuation and a hyperattenuated rim, in addition to its characteristic location adjacent to the colon. In contrast, omental infarction is always centered in the omentum. The most specific finding of appendicitis is a dilated, fluid-filled appendix. Correct noninvasive diagnosis is important because treatment approaches for these conditions range from monitoring to surgery.