Presentation
Right iliac fossa pain, vomiting, fever and leukocytosis.
Patient Data
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.
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.
Case Discussion
Epiploic appendagitis is a differential diagnosis of acute appendicitis, differentiating both lesions is crucial as the latter typically requires surgery, while the other always treated conservatively. Co-existence of appendicitis and its mimicker is very uncommon.