Acute abdomen in adult revealing unusual complicated epiploic appendagitis: A case report

Epiploic appendagitis is a torsion of fatty appendages of ligamentum trees (1), it's a rare cause of abdominal pain that usually manifests by right or left iliac fossa pain, reminding of appendicitis, diverticulitis or ischemia of the omentum.

We report the case of a 56 years old male patient admitted for an epigastric pain and a right-upper quadrant abdominal pain, for whom he underwent an abdominal ultrasound and a CT-scan who shown an abscessed mass under colic transverse to the unusual seat.

CT scan is still the key modality for diagnosis, avoiding unnecessary surgery. Complications of primary epiploic appendagitis have rarely been described in the literature (Hwang et al., 2013; Hasbahceci et al., 2012). Another more rare complication is appendagitis with associated abscess, in this condition, we must also think about complicated diverticulitis. The treatment of uncomplicated forms is generally conservative, however, some authors have suggested a surgical method (Saad et al., 2014). For therapeutic management of its complication, there has been much interest in the use of minimally invasive techniques such as percutaneous drainage to minimize the morbidity and mortality that is associated with surgery (Evidence National Guideline Centre (UK), 2019).

The diagnosis of epiploic appendagitis is still uncommon, CT scan can eliminate other diagnosis of acute abdominal pain such as diverticulitis and appendicitis. It also allows the diagnosis of the rare complicated forms such as abscesses associated with epiploic appendagitis. The treatment of typical forms is usually conservative, while the complicated form requires surgery because of the potential associated pathology.