Epiploic appendagitis: A rare cause of acute abdomen

Abstract

Epiploic appendagitis is a rare cause of acute abdomen that often manifests with acute onset of pain in the left or right lower quadrant. Its symptoms can mimic and be mistaken for acute diverticulitis, appendicitis, or omental infarction. In this case report, we discuss a 65-year-old woman who presented with sharp right upper and lower quadrant abdominal pain, for which she had an emergent abdominal computed tomography (CT) scan. On CT images, epiploic appendagitis will appear as oval lesions with a central area of fat attenuation, accompanied by surrounding inflammation. Ultrasound and magnetic resonance imaging are more often used to evaluate acute abdominal pain in the pediatric and obstetric populations, so the respective findings of acute epiploic appendagitis must be recognized in those examinations as well. Despite the rarity of the condition and its common omission from differential diagnoses, the ability to recognize and diagnose epiploic appendagitis from its imaging is important for radiologists, especially considering its potential complications. If not diagnosed correctly, epiploic appendagitis can result in unnecessary hospital admission and patient workup, antibiotic use, dietary restrictions, and perhaps even unnecessary surgery. In this case, the diagnosis of epiploic appendagitis using CT allowed the patient to avoid surgery and other invasive treatment, and the patient was eventually discharged on conservative medical management.