Acute epiploic appendagitis - a rare differential diagnosis of acute abdomen

Aim Scientific case report (based on experiences obtained in the successful clinical case management and selective references from medical scientific literature).

Case summary Medical history: A 29-year-old female was admitted with abdominal pain in the left lower quadrant. She reported a laparoscopic ovarian cyst removal 3 years ago. Physical examination of the abdomen revealed tenderness in the left lower quadrant without a palpable mass.Leading diagnosis was found using diagnostics, such as transabdominal ultrasound and confirmed by an abdominal CT scan. Therapeutic approach comprised explorative laparoscopy (because of the incarcerated hernia), adhesiolysis, removal of a tip of the greater omentum out of the hernial sac, closure of the hernial orifice, and removal of an unclear, inflamed, and bloody fatty tissue from the wall of the descending colon (histopathological investigation, acute epiploic appendagitis) flanked by conservative treatment of diverticulitis of the sigmoid colon. Further clinical course was uneventful (discharge, on the 3^rd postoperative day) with favorable long-term outcome characterized by no further complaints for 15 months.

Discussion Acute epiploic appendagitis is an inflammatory, usually self-limiting condition of the epiploic appendages of the colon. It typically manifests with abdominal pain in the left lower quadrant. Nevertheless, it is often overlooked in patients and confused with its differential diagnoses, such as appendicitis or diverticulitis. Although the condition appears infrequently, it is essential to be proficient in the diagnostic evaluation, as a misdiagnosis may lead to unnecessary treatment even to surgical intervention.

Conclusion In the described case, the patient was initially diagnosed with an incarcerated abdominal hernia and, therefore, she subsequently underwent surgery. The inflamed epiploic appendage was discovered in laparoscopic exploration, removed, and confirmed through the histopathology report, an approach to be performed with great caution, namely, on one hand, not to i) misinterpret an inflamed diverticula or covered perforation of it as well as ii) overlook a peritoneal tumor lesions.

Publication History

Article published online:
07 September 2021