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

Epiploic Appendagitis: An Important Differential Diagnosis

Epiploic appendagitis is a rare, often misdiagnosed condition that causes acute abdominal pain. The symptoms, such as localized pain that worsens with coughing and stretching, mimic other conditions like appendicitis and diverticulitis. Diagnosis can be made using computed tomography (CT) scans, which show characteristic signs, such as a 2-3 cm fat-density ring, colon wall thickening, and nearby fluid or inflammation. The condition usually resolves naturally or can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs). In this report, a case of a 37-year-old man diagnosed with epiploic appendagitis in the Emergency Department (ED) is presented.

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

BACKGROUND

Epiploic appendages are fatty peritoneal structures on the external surface of the colon that can infarct and become necrotic in situ or autoamputate.

AIMS

To describe clinicopathological features of infarcted epiploic appendages (IEAs).

METHODS

We reviewed 52 IEAs from 49 patients, recording numerous clinical and pathological characteristics, which were compared across attached and loose IEAs.

RESULTS

Twenty-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).

CONCLUSIONS

IEAs have different morphology whether they remain attached to peritoneum or become necrotic and detached. Attached cases may cause symptoms.

Epiploic Appendagitis Causing Small Bowel Obstruction: A Pleasant Surprise

Introduction

Epiploic appendagitis is a rare cause of acute abdominal pain, mimicking acute diverticulitis or appendicitis. Epiploic appendagitis causing small bowel obstruction is highly unusual, and only a handful of such cases have been reported so far. Case Report. A 69-year-old man presented with diffuse abdominal pain and vomiting over the last 12 hours. Clinical examination, laboratory, and imaging investigations showed small bowel obstruction, and after 12 hours of conservative management, surgical exploration was decided. During surgery, a dilated terminal ileum bowel loop was found densely adhered to the sigmoid colon, attached to an inflamed epiploic appendix. The small bowel was mobilized and freed, and the inflamed epiploic appendix was resected. The postoperative course was uneventful, and the patient was discharged on the 5^th postoperative day.

Conclusion

Epiploic appendagitis, although a rare clinical entity, may explain small bowel obstruction symptoms.