Abstract
A 46-year-old female presented to our emergency department (ED) with a 2-day history of right lower abdominal pain which was associated with nausea and anorexia. Abdominal examination revealed tenderness in the right iliac fossa (RIF) with rebound tenderness and a localized guarding. Urine dipstick was normal, and the pregnancy test was negative. Her laboratory investigations were significant only for a CRP of 16.6. A presumptive clinical diagnosis of acute appendicitis was suggested based on the given history and relevant physical signs. However, an abdominal computed tomography (CT) scan revealed an epiploic appendagitis of the caecum with a normal-looking appendix. She was managed conservatively and responded well and was discharged after 2 days in good health. Though being a relatively rare case of acute localized right-sided lower abdominal pain, caecal epiploic appendagitis should be considered as one of the differential diagnoses with the final diagnosis reached usually by the radiological findings due to the nonspecific nature of clinical and laboratory features.
Highlights
Epiploic appendages are pedunculated, fat-filled peritoneal pouches supplied by small blood vessels that form vascular stalks that contain branches of a circular end-artery and a central draining vein that supply the corresponding segment of the colon [1, 2]
Epiploic appendagitis is a relatively rare surgical occurrence, but the true incidence is not yet known. It 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 [6]
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, and the vast majority of the cases are detected incidentally on the computed tomography (CT) scans while investigating or ruling out other intra-abdominal pathologies [7]
Summary
Fat-filled peritoneal pouches supplied by small blood vessels that form vascular stalks that contain branches of a circular end-artery and a central draining vein that supply the corresponding segment of the colon [1, 2]. Epiploic appendagitis is an ischemic infarction of an epiploic appendage caused by torsion or thrombosis of the central draining vein It is an unusual presentation and often a misdiagnosed cause of acute localized abdominal pain mimicking other relatively common entities such as left- or right-sided acute diverticulitis, acute appendicitis, acute cholecystitis, and possibly omental fat infarction and causing a real diagnostic dilemma [2–6]. This would arguably explain its importance as a possible, though rare, differential diagnosis for the acute localized abdominal pain. We present a case of a 46-year-old female patient with a diagnosis of caecal epiploic appendagitis which was initially thought as a case of an acute appendicitis based on the typical history and physical findings of the latter
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