Case Report about Epiploic Appendigitis

Epiploic appendages are peritoneal structures that arise from the outer serosal surface of the bowel wall towards the peritoneal pouch. They are filled with adipose tissue and contain a vascular stalk. Epiploic appendagitis is an ischemic infarction of an epiploic appendage caused by torsion or spontaneous thrombosis of the epiploic appendage central draining vein. The true incidence of epiploic appendagitis is not known. However, epiploic appendagitis has been reported in 2 to 7 percent of patients who were initially suspected of having acute diverticulitis and in 0.3 to 1 percent of patients suspected of having acute appendicitis. Epiploic appendagitis is a rare cause of acute lower abdominal pain. Its clinical features mimic acute diverticulitis or acute appendicitis resulting in being often misdiagnosed as diverticulitis or appendicitis. This frequently leads to unnecessary hospitalization, antibiotic administration, and unwarranted surgeries. Epiploic appendagitis is usually diagnosed with CT imaging, and the classic CT findings include: (i) fat-density ovoid lesion (hyperattenuating ring sign), (ii) mild bowel wall thickening, and (iii) a central high-attenuation focus within the fatty lesion (central dot sign). Upon confirmation, epiploic appendagitis is considered a self-limiting disease and is managed conservatively with analgesics, occasionally combined with Nonsteroidal Anti-Inflammatory Drugs (NSAIDS). Persistence of symptoms or recurrence mandate the consideration of surgical management with laparoscopic appendage excision as the definitive treatment. In this case report, we discuss a 26-year-old woman who presented with a 2-day history of acute left lower abdominal pain.