Case report

An inflamed necrotic appendix epiploicum with immediate contact to a non-inflamed appendix vermiformis: a case report

Michael Sand¹ , Gerd Bonhag¹ , Falk-Georges Bechara² , Daniel Sand³ and Benno Mann¹

¹  Department of General and Visceral Surgery, Augusta Krankenanstalt, Academic Teaching Hospital of the Ruhr-University Bochum, Bergstr 26, 44791 Bochum, Germany

²  Department of Dermatology and Allergology, Ruhr-University Bochum, Gudrunstr 56, 44791 Bochum, Germany

³  Department of Physiological Science, University of California Los Angeles (UCLA), 621 Charles E Young Drive South, Los Angeles, CA 90095-1527, USA

author email corresponding author email

Journal of Medical Case Reports 2009, 3:57doi:10.1186/1752-1947-3-57

Published:	10 February 2009

Abstract

Introduction

Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We describe a patient with an inflamed necrotic appendix epiploicum with immediate contact to a non-inflamed appendix vermiformis mimicking acute appendicitis. Considering the rare localization, this is the first report of this kind in the literature.

Case presentation

We present the case of a 50-year-old Caucasian man who presented with classic signs of acute appendicitis. On clinical exam, McBurney and Blumberg signs were positive. Additionally he had fever, leucocytosis (12/nl) and a slight increase in C-reactive protein (1 mg/dl). Based on the clinical presentation, the patient was taken to the operating room to perform an appendicectomy. Surprisingly, we found an inflamed necrotic appendix epiploicum, located immediately on a non-inflamed appendix vermiformis, which was ligated and excised.

Conclusion

This case report demonstrates that epiploic appendagitis can mimic acute appendicitis on clinical exam and should be considered in the broad spectrum of abdominal disease presenting with right lower quadrant pain.