Laparoscopic Management of Small Bowel Obstruction Caused by Looping of Epiploic Appendages of the Sigmoid Colon: A Case Report

Abstract

Appendices epiploicae are lobulated fatty appendages protruding from the colon and represent a rare cause of intestinal obstruction. We report a case of bowel obstruction caused by a loop formed by adhesions of the epiploic appendages of the sigmoid colon, which was treated laparoscopically. An 86-year-old woman presented to the emergency department with epigastric pain and was diagnosed as having strangulated small bowel obstruction. As the patient had active delirium, we performed laparoscopic surgery following a period of conservative management. Intraoperatively, a segment of small bowel was found to be incarcerated within a loop formed by adhesion between the tips of the appendices epiploicae of the sigmoid colon. We resected the involved appendices epiploicae and released the constricting loop. Including the present case, 12 cases of intestinal obstruction caused by loop-forming appendices epiploicae have been reported in Japan. Adhesions of appendices epiploicae of the sigmoid colon were the most common, and in 75％ of cases, there was no prior history of laparotomy. Preoperative diagnosis remains challenging, as CT findings are often non-specific. Therefore, this rare condition should be considered in patients with strangulated bowel obstruction of unknown cause and no prior history of abdominal surgery. Laparoscopic surgery proved to be an effective diagnostic and therapeutic procedure in this case.