Progressive epiploic appendagitis requiring laparoscopic resection following failure of conservative treatment: a...

Epiploic appendagitis (EA) is a rare, benign, and usually self-limiting cause of acute abdominal pain resulting from inflammation or torsion of an epiploic appendage. It is typically managed conservatively with analgesia and non-steroidal anti-inflammatory medication. We report a case of a 22-year-old male who presented with acute right lower quadrant pain and radiological findings consistent with EA. Despite initial conservative management, he represented with worsening pain and rising inflammatory markers. Repeat imaging demonstrated progression of inflammatory change, atypical for uncomplicated EA. Diagnostic laparoscopy revealed a necrotic epiploic appendage walled off by adherent greater omentum, which was excised. The patient experienced near-immediate symptom resolution and was discharged on post-operative day 1, remaining well at follow-up. Although EA is generally self-limiting, clinical deterioration or atypical radiological development should prompt reassessment. In selected cases, laparoscopy can be both diagnostic and therapeutic.