Epiploic Appendagitis Unveiled: A Case of Misleading Abdominal Pain With Omental Fat Necrosis

Abstract

Epiploic appendagitis is a benign inflammatory condition of the epiploic appendages, small fat-filled structures attached to the colon. Misdiagnosed frequently as more serious conditions like appendicitis or diverticulitis, it usually resolves with minimal treatment. This case report aims to emphasize the importance of recognizing epiploic appendagitis in differential diagnoses, highlighting the role of accurate imaging and surgical intervention in managing unusual presentations. We report a case involving a 27-year-old male who presented with acute, severe pain in the left iliac fossa. Initial assessments showed stable vital signs and negative virology screenings. Ultrasound imaging did not reveal any abnormalities in the abdominal organs but noted multiple gas-filled bowel loops and a 48 x 22 mm collection in the left iliac region. A CT scan with IV contrast further identified a 35 x 26 mm area of fat stranding in the left iliac fossa, indicative of epiploic appendagitis, and a 1 cm area of omental fat necrosis near the hepatic flexure. Persistent symptoms led to a diagnostic laparoscopy, which confirmed and treated gangrenous appendices epiploica. The patient's postoperative recovery was uneventful, highlighting the effectiveness of surgical management. This case underscores the necessity for heightened awareness and diagnostic precision when encountering patients with acute abdominal pain that does not match common ailments. Early and accurate imaging, followed by timely surgical intervention if needed, can significantly improve outcomes by preventing complications from misdiagnosis or delayed treatment.

Keywords: acute abdominal pain; diagnostic imaging; epiploic appendagitis; laparoscopic surgery; omental fat necrosis.

Figure 1. Preoperative abdominal ultrasound shows a collection measuring 48 x 22 mm in the left iliac region.

Figure 2. This intraoperative laparoscopic image shows a clear view of the internal abdominal anatomy, focusing on a section of intestines with visible vascular structures on the surface. A small, yellowish lesion or structure is visible near the center (A), possibly indicative of a pathological finding such as omental fat necrosis (gangrenous appendices epiploica) (B).

Figure 3. The image shows a resected dark reddish-brown lesion, likely a necrotic epiploic appendage, presented against a light-gray background for contrast.