Epiploic appendagitis with acute appendicitis

A 28-year-old woman presented to accident and emergency department with a 1-day history of right-sided abdominal pain. She was afebrile, and haemodynamically stable, and the initial diagnosis was acute appendicitis. A transvaginal ultrasound scan was performed and was suggestive of appendicitis. The patient failed to improve with conservative management, and a laparosocopic appendicectomy was performed the next day to remove an inflamed, non-perforated appendix. Pelvic laparoscopy was performed, which noted normal ovaries and uterus, as well as a hard, swollen, discoloured epiploic appendage of the sigmoid colon. A decision was made not to remove the inflamed epiploic appendage. Postoperatively the patient complained of persisting pain, which settled over 2 days with analgesia and antibiotics. This case is an extremely unusual case of epiploic appendagitis and acute appendicitis. It demonstrates the importance of pelvic laparoscopy in all females with presumed appendicitis, even in the presence of an initial pathology.