Abstract
A 62-year-old man admitted to our department reported right lower abdominal quadrant pain. There was no history of previous surgery. On physical examination tenderness was localized to the right lower abdominal quadrant with associated rebound tenderness and guarding. No palpable masses were found. Abdominal x-ray revealed dilated loops of proximal small bowel with air-fluid level. Computed tomography revealed an oval, fatty paracolic mass lateral to the ascending colon, suggesting surrounding mesenteric inflammation and no appearance characteristic of appendicitis or diverticulitis. Small bowel obstruction due to epiploic appendagitis was diagnosed preoperatively. At laparotomy in emergency surgery we found inflamed appendix epiploica on the ascending colon and adhering to the mesenterium, leading to small bowel obstruction. The obstruction was relieved by lysis of adhesions. The involved appendage was excised and the stump inverted because a diverticulum was found within the appendage. Appendectomy was performed. Pathologycally, there was no inflammation in the appendix or diverticulum, therefore, we diagnosed primary epiploic appendagitis. We review 56 patients with epiploic appendagitis in the Japan literature.
