A rare case of infarcted epiploic appendage due to adhesions after laparoscopic appendicectomy

Introduction Infarction of an epiploic appendage is uncommon and often mimics acute surgical conditions such as appendicitis and diverticulitis. We describe an interesting case of infarction of an epiploic appendage due to adhesions six-weeks after laparoscopic appendicectomy for acute complicated appendicitis. Presentation of Case A 63-year-old male presented with two-days of lower abdominal pain. With raised inflammatory markers and a CT scan demonstrating acute appendicitis, he underwent laparoscopic appendicectomy. Intraoperatively, four-quadrant purulent peritonitis was found with inflammatory adhesions, mid-appendiceal necrosis and perforation. At six-weeks post-operatively, he represented to hospital with right iliac fossa (RIF) pain and a repeat CT scan suggested new collections. Diagnostic laparoscopy was performed and showed a loop of small bowel adherent to the abdominal wall in the RIF which was wrapped around necrotic tissue. This necrotic tissue was an infarcted epiploic appendage. This was resected and he remained well post-operatively. Discussion Infarction of an epiploic appendage is difficult to diagnose due to non-specific symptoms. In most cases, laboratory tests are within the normal range and the characteristic CT finding of a hyper-attenuating ring is not always present. This condition often resolves with conservative management, but rarely surgical resection may be required. Conclusion Infarction of an epiploic appendage is rare, and in this case, it occurred post-appendicectomy. This case highlights that surgeons should consider this as a differential diagnosis for pain after complicated appendicectomy.