The clinical presentation of right iliac fossa pain, anorexia, and vomiting are the classic clinical features of acute appendicitis. However, a broad spectrum of manifestations may result in a similar clinical picture, including gastrointestinal, genitourinary, and gynecologic pathologies. Imaging studies are crucial to establishing the diagnosis. Here, we report the case of a 58-year-old man who presented to the emergency department with a one-week history of right lower quadrant abdominal pain. The pain was associated with nausea, vomiting, and frequent bowel motions. There was no history of fever or weight loss. The examination of the abdomen showed localized tenderness and guarding in the right iliac fossa. The basic laboratory investigation was within the reference range. The computed tomography scan demonstrated a well-circumscribed intraluminal mass lesion in the ascending colon with no evidence of complete obstruction. The mass was slightly heterogeneous but had fat attenuation. There was no evidence of invasion. There was no stranding of the adjacent fat. The radiological findings were consistent with colonic lipoma. The patient underwent laparoscopic surgery and had a segmental resection of the tumor with primary anastomosis. The appendix was also resected. Histopathological examination showed mature adipose cells along with thin-walled, capillary-sized vessels representing a benign angiolipoma. Further, the resected appendix was completely normal and showed no evidence of acute inflammation. Colonic angiolipoma is an extremely rare tumor. This case demonstrated that a large angiolipoma of the ascending colon may show a presenting clinical picture similar to that of acute appendicitis. Complete resection of the tumor is associated with an excellent outcome.

Background: Traumatic bucket-handle mesenteric injury is exceptionally rare, as only 20 cases were reported during the past 63 years. It is a life-threatening injury that is difficult and challenging to detect during bedside physical examination and requires typical diagnostic tests such as CT scan. It occurs when the mesentery avulses off, a bowel loop becomes devascularized and can likewise become ischemic and perforated if left untreated. Most commonly it is caused by motor vehicle crush. Case Presentation: A 23-year-old male was brought to the emergency department as a case of motor vehicle accident with frontal impact. The patient was the driver and wearing the seat belt. Abdominal examination revealed a seat belt sign, generalized tenderness and rigidity, and absence of bowel sound by auscultation. However, patient lacked any related external wounds or injuries. Despite being clinically and vitally stable with no indications requiring the presence of the trauma surgeon, the emergency physician activated the trauma team code based on their clinical judgment. Eventually the patient was taken to operation room for laparotomy as the patient was having acute abdomen, and Bucket-Handle mesenteric tear was identified even though abdomen CT didn't show specific findings. Conclusion: The study concluded that delaying in the diagnosis of traumatic bucket-handle mesenteric injuries and definitive surgical interventions could lead to adverse outcomes and death.

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