Published online Aug 27, 2019. doi: 10.4240/wjgs.v11.i8.342
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.
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.