Epiploic Appendagitis in a Female Patient with Situs Ambiguous Abnormality

Abstract

We report the case of a 23 year-old obese female, with previously diagnosed situs inversus below the diaphragm, who presented with severe left upper quadrant abdominal pain. The patient was believed to have a surgical indication, possibly appendicitis or diverticulitis, and had an emergent abdominal Computed Tomography (CT) scan. The CT was interpreted as epiploic appendagitis with no signs of appendicitis. Epiploic appendagitis is a rare cause of acute abdominal pain, which involves the torsion and eventual necrosis of one of the epiploic appendages. This case was complicated by the fact that the patient had situs inversus below the diaphragm, which made it difficult to relate her localized abdominal pain to the correct anatomic area. The diagnosis allowed the patient to avoid invasive surgery and instead opt for conservative medical management. The utilization of radiologic imaging is of utmost importance in diagnosing this condition, which has characteristic findings on CT, US, and MR, all of which is discussed in this article.