3042 It's Appendagitis, Not Appendicitis!

Abstract

INTRODUCTION: Epiploic appendages are small peritoneal fat pouches located around the colon. There are no specific etiologic factors leading to EA. Because this disorder involves the sigmoid colon, descending colon, and cecum, symptoms often imitate diverticulitis and appendicitis. Although they are found spread all over the serosal surface of the colon, they are much more abundant and larger on the sigmoid and transverse colon walls. Two retrospective studies reported that men (70%) were affected more than women with an age range of 26 to 75 years. CASE DESCRIPTION/METHODS: 66-year-old gentleman with past medical history of hypertension, type 2 diabetes mellitus and hyperlipidemia presented to the outpatient clinic with 1 day history of right lower quadrant pain. Pain was gradual in onset, 6/10 in intensity, throbbing in quality, non-radiating and associated with some nausea and four episodes of non-bloody vomiting. He denied fever, chills, back pain, bloating, hematochezia, constipation, diarrhea or heartburn. Lab work that was done was complete blood count, comprehensive metabolic panel, lipase, and urinalysis which showed a white blood cell count of 11,100 with 9,210 neutrophils but was otherwise unremarkable. CT scan of the abdomen and pelvis demonstrated epiploic appendagitis involving the sigmoid colon. Patient was advised to continue diet and over-the-counter painkillers as analgesia. Patient's symptoms resolved in the next 2 days and he was back to baseline. DISCUSSION: Epiploic appendagitis has been reported in 2-7% of patients with a presumed clinical diagnosis of acute diverticulitis and 0.3-1% of those suspected of having acute appendicitis. Owing to the nonspecific nature of presenting symptoms, physical signs, and laboratory findings, it is extremely difficult to make the correct diagnosis before radiological investigations. Therefore the vast majority of cases are detected incidentally on CT scans while ruling out other intra-abdominal pathologies. CT scan is the gold standard of diagnosis. Our case report is meant to shed light on the diagnosis and management of the condition. It requires only conservative management. Therefore physicians should keep in mind to avoid unnecessary hospitalizations, antibiotic use and surgical interventions. Nevertheless, more common and serious pathological conditions that necessitate urgent surgical or medical interventions should always be ruled out.