A Prodigious Diagnosis of Acute Epiploic Appendagitis: A Rare Case Report

Abstract

Introduction: Appendices Epiploicae, also referred as Epiploic appendages, are 50-100 fat filled finger like projection from the serosal surface of large intestine. Epiploic Appendagitis is a self-limiting, benign disease process which results from the inflammation of these Appendices Epiplocae or thrombosis of the draining vein of Appendices Epiplocae. Case Report: We report a case of 49 year old female, generally well, presented to the Emergency Department with complaints of a painful lump in her left iliac fossa growing in size for last four weeks. She presented to us because of acute increase in size and pain, resulting in significant discomfort. Owing to her history of cervical intra epithelial neoplasia we arranged a CT abdomen and pelvis with contrast fearing some sinister underlying ongoing pathology causing her symptoms. But to our surprise CT reported a underrated cause of her abdominal pain, Epiploic Appendagitis (EA). We were surprised of her presentation as a hard abdominal lump which was quite unusual for EA to present as. We assume it was secondary to an extensive underlying local inflammatory reaction. Patient was reassured and treated with NSAID, antibiotics and follow up with surgery ambulatory care. Conclusion: We authors are reporting this case of primary epiploic appendagitis because we think every emergency and primary care physicians should be aware of this very rare condition which might present to emergency as an acute abdominal presentation mimicking other common presentations like acute diverticulitis and acute appendicitis. Being aware of this condition is utmost important to diagnose it early and avoid more invasive surgical managements and unnecessary antibiotic usage.