Epiploic appendagitis on the vermiform appendix is often misdiagnosed as acute appendicitis

Area of Science:

• Gastroenterology
• Radiology
• Surgical Pathology

Background:

• Epiploic appendagitis (EA) is an uncommon cause of abdominal pain.
• EA of the vermiform appendix mimics acute appendicitis, potentially leading to misdiagnosis and unnecessary surgery.
• Accurate diagnosis relies heavily on imaging due to non-specific clinical and laboratory findings.

Purpose of the Study:

• To highlight epiploic appendagitis of the vermiform appendix as a rare differential diagnosis for right lower quadrant pain.
• To emphasize the importance of accurate imaging in preventing misdiagnosis and unnecessary surgical intervention.
• To review the characteristic imaging findings of appendiceal EA.

Main Methods:

• Case report of a 57-year-old male presenting with right abdominal pain.
• Clinical evaluation, laboratory tests, and computed tomography (CT) imaging were performed.
• Radiological review of CT findings at the vermiform appendix tip.

Main Results:

• Patient presented with right lower abdominal pain and normal laboratory results.
• Initial diagnosis considered distal appendicitis or colonic diverticulitis, treated with antibiotics.
• CT revealed findings consistent with epiploic appendagitis on the vermiform appendix: an oval fat density with a high-intensity rim and central high-density spot.

Conclusions:

• Epiploic appendagitis of the vermiform appendix is a rare condition that can be managed non-surgically with anti-inflammatory drugs.
• Familiarity with clinical and imaging features of appendiceal EA is crucial for accurate diagnosis.
• Distinguishing EA from acute appendicitis via imaging can prevent unnecessary surgical procedures and improve patient outcomes.