Epiploic Appendagitis: A Commonly Overlooked Differential of Acute Abdominal Pain

Abstract

Epiploic appendagitis is an unusual and very commonly overlooked source of acute abdominal pain. Its incidence is highest in middle-aged obese males. It presents clinically as a focal lower quadrant abdominal pain, usually in the absence of pyrexia, nausea, vomiting or change in bowel habit, and unremarkable laboratory markers. Due to its vague presentation, epiploic appendagitis may be mistaken for other more severe causes of acute abdominal pain like diverticulitis and appendicitis, thereby causing patients to undergo unwarranted management interventions and hospital stay. Epiploic appendagitis is usually diagnosed through imaging, most commonly computed tomography (CT). This condition is largely self-resolving and can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). Operative intervention is usually employed when symptoms persist or when complications arise. We present a case of epiploic appendagitis in a patient who presented with right lower quadrant pain initially misdiagnosed as acute appendicitis.

Keywords: acute abdominal pain; appendicitis; diverticulitis; epiploic appendagitis; misdiagnosis.

Figure 1. Ultrasound showing fluid in the ileocecal fossa and a 10 mm appendiceal diameter with periappendiceal inflammation

Figure 2. Arrow showing laparoscopic view of normal appearing appendix.

Figure 3. Intraoperative view of necrotic epiploic appendage before resection.