Acute epiploic appendagitis: a case report and literature review

Acute epiploic appendagitis (AEA) is a rare cause of acute abdomen due to ischemic inflammation of an epiploic appendage, often from torsion or venous thrombosis. We report the case of an elderly woman with acute left lower quadrant abdominal pain, initially suspected of having an abdominal abscess. Clinical examination showed localized tenderness without fever, with mild leukocytosis and elevated C-reactive protein. Ultrasound revealed an oval hyperechoic mass, confirmed by computed tomography (CT) as a hyperdense lesion with a central fatty core, consistent with AEA. Conservative management with non-steroidal anti-inflammatory drugs led to resolution within 7 days. The literature review highlights an incidence of 0.8-2.5% in acute abdomens, with a predilection for obese adults. Diagnosis relies on clinical and imaging findings, with CT as the gold standard. Differential diagnosis includes diverticulitis, appendicitis, and abscesses. An integrated clinical-instrumental approach is essential to avoid unnecessary surgical interventions.