Primary Epiploic Appendagitis Mimicking Acute Appendicitis: A Case Report and Diagnostic Insight

Background and Objective: Epiploic appendagitis is an infrequent and often misdiagnosed cause of acute abdominal pain, commonly mistaken for conditions like appendicitis or diverticulitis due to its nonspecific and localized symptoms. Its underrecognition largely stems from limited clinical awareness and the lack of definitive diagnostic markers, with diagnosis typically made via computed tomography or incidentally during surgical exploration. Case Description: This report presents a rare case of primary epiploic appendagitis in a 35-year-old male initially suspected to have acute appendicitis. Diagnostic laparoscopy revealed a normal appendix and a necrotic epiploic appendage originating from the mid-ascending colon. Laparoscopic excision of the appendage and prophylactic appendectomy were performed. The patient recovered well postoperatively and was discharged on day three, with follow-up confirming full recovery. Histopathology confirmed necrotic epiploic appendagitis. Conclusion: Primary epiploic appendagitis should be considered in stable patients with focal abdominal pain and minimal systemic inflammatory features. In diagnostically uncertain patients, computed tomography can establish the diagnosis and help avoid unnecessary antibiotics, hospitalization, and surgery; reserve operative treatment for selected patients with persistent or worsening symptoms, recurrence, complications, or unresolved diagnostic uncertainty.