Cecal epiploic appendagitis mimicking acute appendicitis in an 8-year-old child: A case report

Abstract

Introduction: Torsion of a cecal epiploic appendage is an uncommon cause of acute abdomen, particularly in children. Diagnosis can be challenging due to the similarities between its symptoms and those of acute appendicitis. We present here a case of cecal epiploic torsion in a child, initially thought to be acute appendicitis. Case presentation: An 8-year-old female child presented with severe acute lower abdominal pain, no fever and no nausea. Laboratory studies showed leukocytosis and elevated inflammatory markers. Pre-operative ultrasound failed to visualize the appendix. Other imaging modalities were not available. The patient underwent an emergency surgery for suspected appendicitis based on the clinical findings. During the operation, a twisted and necrotic cecal epiploic appendage was discovered and resected. The appendix was normal. Histopathological examination confirmed the diagnosis of torsion of cecal epiploic appendages. The patient made an uneventful recovery and was discharged on the fourth postoperative day. Conclusion: Torsion of a cecal epiploic appendix should be considered in the differential diagnosis of children with acute lower abdominal pain, particularly if simple imaging studies fail to demonstrate acute appendicitis. Advanced imaging studies can help with the differential diagnosis, but they are not always available. Surgical excision of the twisted epiploic appendage is curative and the prognosis is generally excellent.

Keywords

• Case report
• Pediatrics
• Appendix
• Cecal epiploic appendagitis
• Abdominal pain