While acute appendicitis is a common cause of acute abdomen, epiploic appendagitis of the vermiform appendix is rare. Apart from the location, they do not have much in common; in fact, both prognosis and treatment options vary grossly. The former is commonly addressed by emergent surgical consultation and appendectomy, while the latter very often being self-limiting and usually treated by pain medication.

The clinical presentation and hospital course of this 50ish female are suggestive of oligosymptomatic epiploic appendagitis of the vermiform appendix a week prior to acute onset of acute appendicitis at the day of presentation to the ER. However, acute appendicitis with insidious onset and secondary torsion of the epiploic appendage cannot be ruled out.

Whichever way, this case highlights the high accuracy of CT in the diagnosis of acute abdomen, especially with the use of multidetector CT scanners and multiplanar reconstructions, as actually both entities were correctly predicted allowing for both timely and curative treatment.