Concurrent Acute Appendicitis and Epiploic Appendagitis: A Rare Clinical Case

Background: Epiploic appendagitis is a rare cause of acute abdominal pain due to ischemia or inflammation of the epiploic appendages, small fat filled structures along the colon. Because of its clinical presentation often mimicking more common conditions such as appendicitis or diverticulitis, it can be a diagnostic challenge. The appendix is equally uncommon in a subhepatic location, and this atypical location adds further to the diagnostic difficulty. Early recognition and treatment are important to prevent complications and to ensure effective treatment. Case Presentation: A non-hypertensive, non-diabetic male presented with a 3-day history of continuous right upper quadrant pain, accompanied by nausea and vomiting. Physical examination revealed right upper quadrant tenderness with rebound tenderness, while laboratory tests showed elevated inflammatory markers. Ultrasound findings included a non-compressible, edematous blind loop in the subhepatic region measuring 9.2 mm in diameter. It is surrounded by stranded mesenteric fat, echogenic mesocolic fat, colonic wall edema, and a minimal free fluid collection. Based on these findings, subhepatic acute appendicitis with associated acute epiploic appendagitis was diagnosed. The patient underwent emergency laparoscopic appendectomy and removal of the inflamed epiploic appendages. Intraoperative findings confirmed a suppurative appendix in the subhepatic region and thickened epiploic appendages surrounded by inflamed tissue. Histopathological analysis corroborated features of subhepatic appendicitis and epiploic appendagitis. Conclusion: The diagnostic and surgical complexities of subhepatic appendicitis and epiploic appendagitis are illustrated in this case. Laparoscopic surgery remains a safe and effective treatment and imaging is important in identifying atypical presentations. Management of atypical acute abdominal pain presentations requires awareness of these conditions.