[A rare cause of acute abdomen: epiploic appendagitis]

Area of Science:

• Gastroenterology
• Radiology
• Pediatric Surgery

Background:

• Primary epiploic appendagitis is a rare, self-limiting condition involving torsion or inflammation of the epiploic appendages.
• Historically, diagnosis was challenging, often requiring surgical exploration due to its rarity and non-specific symptoms.

Observation:

• A 14-year-old overweight male presented with worsening right iliac fossa pain over six days.
• Physical examination revealed localized tenderness, but laboratory tests and urinalysis showed no signs of infection or inflammation.
• Abdominal X-ray was inconclusive; however, a CT scan revealed characteristic findings suggestive of epiploic appendice torsion.

Findings:

• CT scan demonstrated fat infiltration and a hyperdense ring surrounding a fat-containing shuttle image at the coeco-appendicular junction, indicative of epiploic appendice torsion.
• The absence of inflammatory markers and normal urine cytology ruled out other common causes of acute abdominal pain.

Implications:

• Advanced imaging, particularly CT scans, significantly improves the preoperative diagnosis of primary epiploic appendagitis.
• Accurate non-invasive diagnosis allows for conservative, symptomatic management, preventing unnecessary surgical interventions and associated risks.