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Case Report
Acute mucosal appendicitis and epiploic appendagitis in an adult: A rare 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
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How to cite this article
Tran QR, Raniga H, Arafat Y, Mizumoto R, Lucky T, Ratnayake S. Acute mucosal appendicitis and epiploic appendagitis in an adult: A rare case report. Int J Case Rep Images 2020;11:101093Z01QT2020.ABSTRACT
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
SUPPORTING INFORMATION
Author Contributions
Quoc (Ryan) Tran - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Hamish Raniga - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Yasser Arafat - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ryo Mizumoto - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Tarana Lucky - Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Sujith Ratnayake - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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.
Copyright© 2020 Quoc (Ryan) Tran et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
