Epiploic appendagitis on the vermiform appendix is often misdiagnosed as acute appendicitis.

Abstract

Epiploic appendagitis of the vermiform appendix is a rare cause of right lower abdominal pain that can mimic acute appendicitis and result in unnecessary surgery. Despite this, the condition can be managed with non-steroidal anti-inflammatory drugs alone. Due to the lack of characteristic physical or laboratory findings, accurate diagnosis by imaging is crucial. The aim of this case report is to emphasize this uncommon condition to prevent misdiagnosis and avoid unnecessary surgical interventions. A 57-year-old man presented with a 2-day history of abdominal pain and tenderness in the right abdominal region. Laboratory results were within the normal range. The surgeon diagnosed him as distal appendicitis or colonic diverticulitis and treated him with antibiotics, leading to improvement within several days. A subsequent review of the plain computed tomography images by the radiologist detected an oval fat density surrounded by a high-intensity rim and a high-density spot in the center at the tip of normal vermiform appendix. This led to a diagnosis of epiploic appendagitis on the vermiform appendix. Epiploic appendagitis is characterized by inflammation and ischemia resulting from torsion of the epiploic appendage. It can occur not only on the colon but also on the appendix. The imaging findings in this case were typical of epiploic appendagitis on the appendix. It is imperative for clinicians to be familiar with the clinical presentation and imaging findings of epiploic appendagitis on the appendix to ensure an accurate diagnosis, reduce unnecessary surgeries, thereby enhancing patient outcomes.