A CASE OF EPIPLOIC APPENDAGITIS MIMICKING ACUTE APPENDICITIS

Abstract

Epiploic appendagitis is a rare inflammatory disease of the epiploic appendage and is thought to caused by impaired circulation due to volvulus of the epiploic appendage. Only 27 cases have been seen in the Japanese literature as far as we could review. Recently we experienced a case of epiploic appendagitis mimicking acute appendicitis. A 33-year-old man was admitted to the hospital because of right lower abdominal pain. Acute appendicitis was suspected from clinical symptoms and the patient underwent laparotomy. During surgery no evidence of acute appendicitis was found but a pedunculated epiploic appendage of the cecum with the size of tip of the thumb discoloring to black was revealed. It could be determined epiploic appendagitis of impaired circulation type due to volvulus. The lesion was removed. Histopathologically, the appendage showed marked congestion and slight bleeding with infiltration of inflammatory cells, suggesting the ischemic change. It is difficult to made distinction among acute appendicitis, diverticulitis and epiploic appendagitis before operation. In fact, no correct preoperative diagnosis has been made in the 27 cases of epiploic appendagitis reported in Japan. When we encounter a case of acute abdomen in which laparotomy findings do not coincide with clinical findings, we should bear a possibility of the disease in mind to explore the surrounding epiploic appendage.