Korean J Gastroenterol.  2020 Aug;76(2):88-93. 10.4166/kjg.2020.76.2.88.

Primary Epiploic Appendagitis Mimicking Acute Appendicitis: A Case Report and Narrative Review of the Literature

• Kefala MA
• Tepelenis K
• Stefanou CK
• Stefanou SK
• Papathanakos G
• Kitsouli A
• Tepelenis N
• Kitsoulis P

• KMID: 2505871
• DOI: http://doi.org/10.4166/kjg.2020.76.2.88

Abstract

Primary epiploic appendagitis is uncommon and is estimated to induce 1.1–1.3% of all abdominal pain. We report a 42-year-oldmale who appeared in the morning in the emergency department with abdominal pain localized in the right lower abdomen andassociated with anorexia and nausea. Clinical examination, laboratory tests, and abdominal ultrasound revealed deep tendernessat Mc Burney point and a mild elevation of CRP (0.7 mg/dL). In the evening, the symptoms were exacerbated, and a diagnosticlaparoscopy was performed. Intra-operatively, the appendix was normal and a twisted, necrotic epiploic appendage originatingfrom the antimesenteric border of the mid ascending colon was found. Laparoscopic resection of the necrotic epiploic appendageand prophylactic appendectomy was carried out. Histology indicated the diagnosis of the necrotic epiploic appendage.Postoperatively, the patient recovered without complications. Although the preoperative diagnosis of primary epiploic appendagitishas improved due to abdominal ultrasound and mainly CT, there are still cases which are diagnosed during laparoscopy. Thetreatment of choice is conservative management, while the use of antibiotics remains controversial. The relapse and complicationrates are rare. Surgical excision, particularly laparoscopic, should be considered in cases of uncertain diagnosis, persistentsymptoms, or recurrence.

Keyword

Epiploic appendagitis; Torsion of epiploic appendage; Necrosis of epiploic appendage; Infarct of epiploic appendage

Figure

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  Fig. 1 Abdominal ultrasound: The vermiform appendix is not visualized, and no free fluid is found. The only finding was probe tenderness in the right iliac fossa.

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  Fig. 2 Surgical specimens: (A) the vermiform appendix appears normal, while (B) a twisted, necrotic epiploic appendage originating from the antimesenteric border of the mid ascending colon is identified. (C) The two surgical specimens are placed alongside.

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