Cecal epiploica appendix torsion in a female child mimicking acute appendicitis: a case report

Abstract

Acute appendicitis is the most common cause of the right lower quadrant acute abdominal pain in children. Some other conditions including cecal epiploica appendix torsion, can simulate acute abdomen. Epiploica appendix torsion usually occurs in the sigmoid colon and rarely in the cecum of adult males. In children, this entity is extremely rare and may represent a diagnostic and therapeutic dilemma. We report a case of an 8-year-old Greek girl, presented with signs and symptoms mimicking acute abdomen. Our patient is the younger one among the other four with cecal epiploica appendix torsion that had been reported in the literature.

Epiploic appendagitis of caecum: a diagnostic dilemma

“…This disease does not seem to have a sex predilection [11]; however Szunyogh et al found an abnormally high incidence in females [12]. Epiploic appendagitis is rarely seen in patients younger than 19 years and is almost unknown in children [3], [4]. Only few case reports of epiploic appendagitis involving caecum in children have been published in literature [3], [4].…”

“…Epiploic appendagitis is rarely seen in patients younger than 19 years and is almost unknown in children [3], [4]. Only few case reports of epiploic appendagitis involving caecum in children have been published in literature [3], [4]. One report has suggested obesity as a risk factor [2].…”

“…These findings differentiate it from omental infarction. Magnetic resonance findings include an ovoid fat intensity with a central dot on T1 and T2 weighted images, which possess an enhancing rim with gadolinium [3]. The above mentioned findings have been seen in adults and, experience with these investigations is limited in children.…”

“…If it involves the caecum, it may mimic acute appendicitis or any other cause of acute pain in the right lower abdomen like regional enteritis, ovarian torsion, salpingoophoritis, typhillitis and perityphillitis [2]. Epiploic appendagitis occurs usually beyond the fourth decade of life; and only few anecdotal reports of caecal epiploic appendagitis involving young children have been published till date [3], [4]. We present here a case of a 7-year-old boy misdiagnosed preoperatively as acute appendicitis; who was later upon surgical exploration found to have caecal epiploic appendagitis.…”

Appendicitis epiploicae: a rare cause of acute abdomen

“…Laboratory investigations have been found to be inconclusive, and usually suggest a normal or slightly elevated leucocyte count 2 , 3. The radiological evaluation in the form of abdominal ultrasound examination and computed tomography (CT) scan has been found to be useful in the preoperative diagnosis in patients with appendicitis epiploicae.…”