Case report: Caecal epiploic appendagitis mimicking acute appendicitis

Abstract

IntroductionAcute appendicitis is a very common cause of abdominal pain which is optimally treated surgically. On the other hand, epiploic appendagitis is a self-resolving condition typically managed with analgesia alone, which can also present with severe abdominal pain. Both can present similarly and be difficult to distinguish. CaseA 38 year old male presented with 2 days of periumbilical and right iliac fossa pain, with features of localised peritonism on physical exam. Inflammatory markers were only very mildly elevated but a computed tomography scan demonstrated findings in keeping with mild acute appendicitis. OutcomeLaparoscopic appendectomy demonstrated a torted epiploic appendage immediately adjacent to the vermiform appendix. The appendix had very mild inflammatory changes at the base adjacent to the appendage, but otherwise normal macroscopic appearance. Histopathology confirmed periappendicitis without features of acute appendicitis. ConclusionRight sided epiploic appendagitis can mimic acute appendicitis, and in select patients with right iliac fossa pain there may be a role for serial observation to avoid an unnecessary operation.