Acute epiploic appendagitis: A rare cause of acute abdomen and a diagnostic dilemma

Abstract

Acute epiploic appendagitis is a relatively rare cause of lower abdominal pain that clinically mimics other acute abdomen conditions that require surgery such as acute diverticulitis or appendicitis. Here, we report a case of a 50-year-old lady who presented with an unusual lower abdominal pain. Awareness of such a clinical condition with its characteristic imaging findings is important to avoid costly hospitalization, unnecessary antibiotic courses, and the morbidity and mortality associated with surgical procedures.

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

“…Acute epiploic appendagitis (AEA), first described by Lynn et al in 1956, is one of the rare causes of acute abdomen secondary to the inflammation of the EA, which are 0.5-5 cm long and 1-2 cm thick serosa-covered fat pad pouches of the colonic wall[11,12]. Although the EA are distributed along the entire colon (50-100 in total), they are mostly populated in the rectosigmoid junction (57%), ileocecal region (26%), ascending colon (9%), transverse colon (6%) and descending colon (2%)[12].…”

“…Primary acute epiploic appendagitis (PAEA) is caused by torsion or spontaneous venous thrombosis of the involved epiploic appendage, while secondary epiploic appendagitis (SEA) is associated with inflammation of adjacent organs, such as diverticulitis, appendicitis or cholecystitis[13]. Moreover, the PAEA presents mostly in 2-5 decades of life without any sexual predominance, while SEA affects mostly middle-aged obese male population[3,11-13]. Also, the most common parts of the colon affected by AEA in decreasing order of frequency are the sigmoid colon, descending colon, cecum and the ascending colon[13].…”

Epiploic appendagitis diagnosis linked to intestinal symptoms: Case reports

“…It is considered a self-limiting benign condition caused by torsion or thrombosis which leads to ischemia of the fat structures. Ischemia, in turn, causes localized sharp abdominal pain, especially on the lower left abdomen quadrant (in 76% of cases) 2,3 . Appendagitis mostly affects male patients in their 40s to 50s 1,3 .…”