Abdominal Emergencies

Right lower quadrant pain: not always appendicitis but epiploic appendagitis of appendix

Epiploic appendagitis is a condition that mimics acute abdomen, causing inflammation of epiploic appendages. This paper aimed to present a case of "epiploic appendagitis of the appendix", which is a rare cause of right lower quadrant pain. A 45-year-old male patient with abdominal pain was referred to the radiology clinic for abdominal CT. The pain localized to the right lower quadrant and no signs of peritoneal irritation were present on physical examination. On images of abdominal CT the diameter of the appendix measured as 7 mm. The wall thickness was within normal limits and no mucosal enhancement noted. Appendiceal air was present in the lumen. An oval lesion of fat density with a hyperdense rim was seen adjacent to the anterior part of the appendix. It was causing striations and heterogeneous appearance in the surrounding mesenteric fat tissue with central areas of high attenuation. The findings noted down as “hyper-attenuating ring sign” and “central dot sign”. These pathognomonic CT findings were consistent with epiploic appendagitis and the case reported as epiploic appendagitis of the appendix. After conservative non-surgical medical treatment symptoms of patient revealed. To prevent unnecessary surgery, it is important to exclude conditions requiring emergency surgical intervention with imaging. The most effective technique recommended for imaging is CT with IV opaque. Increasing awareness and knowledge of radiologists regarding epiploic appendagitis of the appendix will rule out the possibility of potential misdiagnosis in imaging and will avoid the resultant unnecessary surgery.