Co-existing acute appendicitis and epiploic appendagitis

Case contributed by Dr Ahmed Samir Mehany

Presentation

Right iliac fossa pain, vomiting, fever and leukocytosis.

Patient Data

Age: 30 years
Gender: Male
  • The appendix is enlarged measures 9 mm diameter at its tip with increased wall thickness and enhancement, mild surrounding fat stranding, no extraluminal air or localized collection.

  • A small oval-shaped lesion measures 8 mm seen at the posterior wall of the ascending colon with a fatty core (-11 HU) showing minimal stranding of the adjacent fat, findings are suggestive of epiploic appendagitis.

  • Mild free pelvic fluid.

  • The appendix is enlarged measures 9 mm diameter at its tip (yellow arrowhead) with increased wall thickness and enhancement.

  • A small oval-shaped lesion (red arrow) measures 8 mm seen at the posterior wall of the ascending colon with a fatty core ( -11 HU) showing minimal stranding of the adjacent fat, findings are suggestive of epiploic appendagitis.

Case Discussion

Epiploic appendigitis is a differential diagnosis of acute appendicitis, differentiating both lesions is crucial as the later requires immediate surgical interference while the other always treated conservatively.

Co-existence of appendicitis and its mimicker is very uncommon.

Operative notes: Inflamed appendix with intact base, a single inflamed epiploic appendage just above the cecum. The appendix was removed, while the inflamed appendage was not touched. 

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Case information

rID: 61789
Published: 7th Aug 2018
Last edited: 8th Aug 2018
Inclusion in quiz mode: Included

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