Descending Colon Epiploic Appendagitis Mimicking Diverticulitis: A Case Report

Epiploic appendagitis is a rare, self-limiting cause of acute abdominal pain that often mimics more common conditions, such as diverticulitis, leading to frequent misdiagnosis and unnecessary interventions. We report a case of a 46-year-old male who presented with sudden-onset, sharp, localized left lower quadrant pain without systemic symptoms. Physical examination revealed localized tenderness without peritoneal signs, and laboratory tests showed only mild leukocytosis and slight elevation of inflammatory markers. Contrast-enhanced computed tomography demonstrated an oval, fat-density lesion adjacent to the descending colon with a hyperattenuating rim and surrounding fat stranding, consistent with epiploic appendagitis. The patient was managed conservatively with analgesia and supportive care, with rapid symptom resolution within 48 h and complete recovery at two-week follow-up. This case highlights the importance of considering epiploic appendagitis in the differential diagnosis of acute abdominal pain, particularly when systemic signs are minimal, and demonstrates the value of imaging in establishing a definitive diagnosis. Prompt recognition can prevent unnecessary antibiotics, hospitalization, or surgical intervention, allowing for safe and effective conservative management.