A mysterious cause of a surgical abdomen

Epiploic appendagitis is a rare cause of acute-onset abdominal pain. The severity of pain at presentation and the infrequency with which it is encountered make it a diagnostic challenge.

To present a case report exemplifying a diagnostic challenge posed by acute-onset abdominal pain that eventually led to the diagnosis of epiploic appendagitis.

A 50-year-old woman presented to the Emergency Department complaining of excruciating, sudden-onset lower abdominal pain. All routine laboratory investigations were within normal limits, as were an acute abdominal X-ray series. Computed tomography scan of the abdomen and pelvis with contrast showed a focal fatty infiltration in the left lower quadrant with fat-stranding towards the colon, representing the classical radiological presentation of epiploic appendagitis. The patient was admitted and successfully managed conservatively with intravenous fluids and ibuprofen. The patient made a full recovery and was discharged 3 days after admission.

Due to its benign, self-limited course, it is important to recognize this disease process to avoid unnecessary surgical and medical interventions. Epiploic appendagitis should be suspected in patients presenting with acute onset abdominal pain localized to the left lower quadrant or right lower quadrant with no associated systemic manifestations. Improvements in imaging technology have enabled confirmation of the diagnosis with non-invasive methods.