Acute Epiploic Appendagitis Mimicking Ovarian Torsion: A Case Report Highlighting Diagnostic Challenges

BACKGROUND Acute epiploic appendagitis is an uncommon cause of acute abdominal pain characterized by pain in the left or right lower quadrants of the abdomen. It is caused by torsion or spontaneous venous thrombosis of one of the epiploic appendages, which are found along the colon, most commonly in the sigmoid colon. The literature consistently compares the presenting symptoms and clinical picture of acute epiploic appendagitis to acute diverticulitis and acute appendicitis. However, ovarian torsion is not reported as a differential diagnosis for this pathology in the literature. CASE REPORT This case report demonstrates a female patient in her late 30s presenting with acute left iliac fossa pain associated with vomiting, in the context of a negative beta-hCG blood test. The history of severe unilateral intermittent pelvic pain progressing to constant pain associated with vomiting led to a working differential diagnosis of ovarian torsion. A bimanual vaginal examination was positive for tenderness in the left iliac fossa with no palpable adnexal masses or cervical motion tenderness. Therefore, the patient underwent an emergency diagnostic laparoscopy and was found to have normal ovaries, with torsion of an epiploic appendage identified. A diagnosis of acute epiploic appendagitis was made. CONCLUSIONS This case report demonstrates the importance of considering acute epiploic appendagitis as a rare differential diagnosis for ovarian torsion in female patients. With the management of this pathology being non-operative, identification of this condition on ultrasound or computed tomography is essential in avoiding unnecessary surgery for patients with this pathology.