Laparoscopic diagnosis and management of an inflamed epiploic appendage with torsion and necrosis

Abstract

Acute epiploic appendagitis, caused by torsion, inflammation and necrosis of an appendix epiploica, is a rare clinical entity that can be easily misdiagnosed as acute appendicitis or diverticulitis. We report a case of a 23-year-old male, who presented to the emergency department complaining of an intense and persistent abdominal pain, localized to the left lower quadrant, accompanied by nausea. The suspicion of epiploic appendagitis was established by the findings of a contrast-study computed tomography of the abdomen. A diagnostic laparotomy was subsequently undertaken due to clinical deterioration of the abdominal pain despite antibiotic coverage. A necrotic epiploic appendage of the descending colon was revealed, which was removed laparoscopically. Laparoscopic exploration, diagnosis and secure management in acute abdominal conditions is highly recommended in the surgical literature and its value was proven once again in the herein presented case.