Acute epiploic appendagitis at the tip of the appendix mimicking acute appendicitis: A rare case report with literature review

BackgroundEpiploic appendages are fatty peritoneal structures on the external surface of the colon that can infarct and become necrotic in situ or autoamputate.AimsTo describe clinicopathological features of infarcted epiploic appendages (IEAs).MethodsWe reviewed 52 IEAs from 49 patients, recording numerous clinical and pathological characteristics, which were compared across attached and loose IEAs.ResultsTwenty-seven IEAs were attached, and 23 were loose; location was unclear in 2. Most were incidental; 3 attached cases caused ‘appendagitis’. Most (31, 60%) had a classic ‘egg-like’ appearance. Common findings included fat necrosis (84%), calcification (67%) and fibrosis (58%). Attached cases had a larger mean size (1.8 cm vs 1.3 cm, p=0.030) and were more often haemorrhagic (37% vs 4%, p=0.0064) and inflamed (67% vs 13%, p=0.0002). Loose cases were more often necrotic (100% vs 74%, p=0.011).ConclusionsIEAs have different morphology whether they remain attached to peritoneum or become necrotic and detached. Attached cases may cause symptoms.

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Primary Epiploic Appendagitis of the Appendix Vermiformis

Kahveci

Zitouni

Abubakar³

et al. 2023

CMIR

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Introduction: Introduction: Primary epiploic appendagitis, a relatively rare and self-limiting disease, often clinically mimics conditions of acute abdomen such as acute appendicitis and acute diverticulitis. It is important to make accurate diagnoses because its treatment is conservative. Ultrasonography and computed tomographic studies enable a reliable diagnosis to prevent unnecessary invasive procedures. Here-in, we report a case of primary epiploic appendagitis of the appendix vermiformis with clinical, laboratory and CT findings in order to improve awareness of this condition. Case Presentation: A 29-year-old female presented with acute abdominal pain in the right lower quadrant. Her medical history was not significant for surgery. She had no nausea, vomiting, diarrhea or fever. On physical examination she had right lower quadrant tenderness with mild defense and rebound upon palpation. The leukocyte count (6300 mm-3) and other laboratory parameters including urine tests were unremarkable. With these findings the provisional diagnosis of acute appendicitis was made and CT examination (Mx 8000 IDT 16, Philips, USA) was done upon the request of the referring physicians. The abdominal CT showed normal appendix vermiformis. However, a fat density lesion surrounding a hyperdense rim was seen adjacent to the appendix vermiformis (Fig. 1). The diagnosis of PEA was thus established based on the characteristic radiologic findings. The patient was managed conservative treatment with pain medication as outpatient. After a one week follow-up the patient was observed to be symptom-free and concluded to has recovered fully by their physician.. Conclusion: To conclude, PEA needs to be considered by emergency clinicians and radiologists in the differential diagnosis of acute abdominal pain. With this in mind it becomes easier for a substantive diagnosis to be made by ultrasound alone or in combination with CT to prevent unnecessary surgical interventions, antibiotherapy and hospitalizatio

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Acute epiploic appendagitis at the tip of the appendix mimicking acute appendicitis: A rare case report with literature review

Cited by 6 publications

References 19 publications

Torsion and necrosis of a fatty appendix of the vermiform appendix

Torsion and necrosis of a fatty appendix of the vermiform appendix

Clinicopathological differences in attached versus loose infarcted epiploic appendages: an analysis of 52 cases

Primary Epiploic Appendagitis of the Appendix Vermiformis

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