Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2019; 11(8): 342-347
Published online Aug 27, 2019. doi: 10.4240/wjgs.v11.i8.342
Acute epiploic appendagitis at the tip of the appendix mimicking acute appendicitis: A rare case report with literature review
Kai Huang, Abdul Waheed, William Juan, Subhasis Misra, Cristiano Alpendre, Stephen Jones
Kai Huang, Abdul Waheed, William Juan, Subhasis Misra, Cristiano Alpendre, Stephen Jones, Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
Author contributions: Huang K, Alpendre C and Jones S designed the case report, Juan W performed the literature search and informed consent; Huang K wrote the manuscript, Waheed A and Misra S revised the manuscript.
Informed consent statement: Informed consent for the publication of this work has been obtained.
Conflict-of-interest statement: None of the authors report a conflict of interest regarding this case report.
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Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Kai Huang, MD, Department of General Surgery, Brandon Regional Hospital, 119 Oakfield Dr, Brandon, FL 33511, United States.
Telephone: +1-813-5413043 Fax: +1-813-6626200
Received: March 8, 2019
Peer-review started: March 11, 2019
First decision: April 18, 2019
Revised: June 4, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: August 27, 2019

Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation of acute appendicitis (AA). To date, very few cases of AEAA have been reported. We report a case of a 52-year old man with the clinical suspicion of AA, but post-operative specimen examination confirmed AEAA as the final diagnosis.


A 52-year-old morbidly obese man presented to the emergency department with a 1-d history of the right lower quadrant (RLQ) abdominal pain. Physical examination revealed localized RLQ tenderness mimicking AA. The computed tomography abdomen was inconclusive, and a decision was made to perform laparoscopic appendectomy (LA). During the LA, an infarcted epiploic appendage at the tip of appendix and adherent to the abdominal wall was found, which was entirely excised. Final pathology showed congested and hemorrhagic epiploic appendage without any accompanied acute inflammatory changes in the wall of the appendix. Postoperative course was uneventful and he was doing well at seven months follow-up.


The possibility of AEAA should be considered in patients clinically suspected of having AA. Surgery is considered for those refractory to conservative management, with inconclusive diagnosis or develop complications at presentation.

Keywords: Acute epiploic appendagitis of the appendix, Acute epiploic appendagitis, Acute appendicitis, Case report

Core tip: Acute appendiceal epiploic appendagitis is very rare condition challenging to differentiate from acute appendicitis clinically. Computed tomography abdomen plays a crucial role in diagnosis, while pain control with anti-inflammatory drugs is the treatment of choice. Surgery is only considered for those refractory to conservative management or develop complications at presentation.