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Case Reports
. 2023 Aug 23;2023(8):rjad483.
doi: 10.1093/jscr/rjad483. eCollection 2023 Aug.

A rare case of epiploic appendages infarction within an incisional hernia: a usual complain of unusual cause

Elias Edward Lahham  1 , Qusai A Alsalah  2 , Mohammad I Alsahouri  2 , Abdalrazeq Ghweir  2 , Mohammad AlQadi  3 , Nafez Sarhan  4
Affiliations
Case Reports

A rare case of epiploic appendages infarction within an incisional hernia: a usual complain of unusual cause

Elias Edward Lahham et al. J Surg Case Rep. .

Abstract

Epiploic appendagitis (EA) is an uncommon condition caused by infarction of epiploic appendages "small fat outpouchings present on the outside of the colon wall" because of torsion or thrombosis of the main draining vein. It is sometimes misdiagnosed as diverticulitis or appendicitis. Lab tests usually are normal, and the diagnosis is mainly by computerized tomography (CT) scan. Treatment is conservative as it is a self-limited condition, and the symptoms will resolve spontaneously within 2 weeks. However, surgical appendage removal could be necessary if symptoms increase or continue. Here, we report our experience with a 21-year-old male patient, who presented with a 1-day duration of localized right lower quadrant (RLQ) abdominal pain within 18*10 cm incisional hernia, imaging revealed signs of epiploic appendages infarction within the huge incisional hernia. This case describes an atypical scenario for EA, which was successfully managed with surgery. The final pathology report confirms the diagnosis.

Keywords: epiploic appendages infarction; epiploic appendagitis; right lower quadrant painincisional hernia.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Abdomen CT scan with IV contrast demonstrated a large m peritoneal defect containing cecum and terminal ileum with an oval fatty density 1.5*2 cm represent an inflamed epiploic appendages (arrow) that have a hyper-attenuating rim and “central dot sign” with inflammatory changes in the adjacent fat tissue.
Figure 2
Figure 2
Operative findings: (A) infarcted epiploic appendages, (B) cecum, (C) ascending colon, (D) hernial sac.
Figure 3
Figure 3
The removed specimen: edematous-infarcted epiploic appendage, measure 3*3 cm (A) and a free fatty body (B) found in the hernia sac.
See this image and copyright information in PMC

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