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

Abstract

Background: 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.

Case summary: 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.

Conclusion: 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 appendicitis; Acute epiploic appendagitis; Acute epiploic appendagitis of the appendix; Case report.

Figure 1

Abdominal computed tomography scan. A 1.0 cm × 1.8 cm focus of oval inflammatory changes surrounding central fat density visualized adjacent to the tip of the appendix and inferior aspect of the cecum noted. This is likely due to epiploic appendagitis. Possibility of very early acute distal tip appendicitis cannot be entirely excluded but felt to be less likely (Short arrow: Appendix; Long arrow: Epiploic appendagitis).

Figure 2

Infarcted appendiceal epiploic appendage at the tip of the appendix (Intraoperative).

Figure 3

The Congested and hemorrhagic appendage. A: The congested and hemorrhagic appendage measures 6.3 cm × 1.6 cm × 1 cm; B: Serosal surface with fibrin and few acute inflammatory cells. Muscular layer with no inflammatory cells. High power.