Case Report
1 Department of Surgery, Toowoomba Hospital, Toowoomba, Australia
2 School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
3 Department of Surgery, Caboolture Hospital, Caboolture, Queensland, Australia
4 School of Medicine, Griffith University, Queensland, Australia
Address correspondence to:
Quoc (Ryan) Tran
Toowoomba Hospital, Pechey St, South Toowoomba, Queensland 4350,
Australia
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Article ID: 101093Z01QT2020
Introduction: Concurrent presence of two distinct pathologies, such as acute mucosal appendicitis with epiploic appendagitis, is unusual and can often lead to a management dilemma for surgeons. Here, we present a case description of this clinical rarity and reviewed the available literature in managing this rather uncommon but potentially life-threatening clinical condition.
Case Report: A 44-year-old male presented to the emergency department with a one-day history of nonmigratory acute right iliac fossa pain. Clinical examination revealed right iliac fossa tenderness with positive rebound sign. Biochemical tests were generally insignificant. Abdominal computed tomography (CT) showed features suggestive of acute appendicitis (diameter of appendix was 7 mm and inflammatory changes noted in the mid part). Based on these findings, a laparoscopy was performed. Intraoperatively, there was a macroscopically normal appearing appendix and an anticlockwise rotation of necrotic epiploic appendage. The necrotic tissue was transected followed by a planned appendicectomy. The histology confirmed the presence of both epiploic appendagitis and mucosal appendicitis. Overall, the patient had an uneventful postoperative recovery and was discharged on postoperative day one.
Conclusion: Due to the benign and self-limiting nature of epiploic appendagitis, the need for emergent laparoscopy is generally not required in most cases. However, in the context of co-existing acute appendicitis, definitive management with laparoscopic removal of inflammatory/necrotic tissues followed by appendectomy appears to be an acceptable management option.
Keywords: Appendicitis, Appendagitis, Management, Mucosal
Quoc (Ryan) Tran - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Hamish Raniga - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yasser Arafat - Revising it critically for important intellectual content, Final approval of the version to be published
Ryo Mizumoto - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Tarana Lucky - Drafting the article, Final approval of the version to be published
Sujith Ratnayake - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
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