A differential for right iliac fossa pain and the importance of consenting properly

Abstract

A 39-year-old man presented with a 2-day history of central abdominal pain which had subsequently localised to the right iliac fossa, with clinical signs of tenderness with guarding in the right iliac fossa. With these classical signs, he was diagnosed with probable appendicitis and a laparoscopy with a view to appendicectomy was arranged. At laparoscopy, a torted, dusky-looking ischaemic greater omentum was found and resected. When performing laparoscopy for suspected appendicitis, it is important to look for other unexpected pathology and treat it as the situation requires, if the appendix is normal at the time of laparoscopy. The possibility of other pathologies to account for the patient's symptoms must not be overlooked.

Figure 1

The resected omentum. The pedicle, about which it had torted, is on the right of the picture.