A Case of Small Bowel Obstruction due to Primary Epiploic Appendagitis

Tomoaki Takada¹⁾²⁾, Hideaki Yosida¹⁾, Morio Tsukada¹⁾, Shunichi Okushiba²⁾ and Hiroyuki Katoh²⁾

¹⁾Department of Surgery, Yoichi Kyokai Hospital, ²⁾Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine

A 62-year-old man admitted to our department reported right lower abdominal quadrant pain. There was no history of previous surgery. On physical examination tenderness was localized to the right lower abdominal quadrant with associated rebound tenderness and guarding. No palpable masses were found. Abdominal x-ray revealed dilated loops of proximal small bowel with air-fluid level. Computed tomography revealed an oval, fatty paracolic mass lateral to the ascending colon, suggesting surrounding mesenteric inflammation and no appearance characteristic of appendicitis or diverticulitis. Small bowel obstruction due to epiploic appendagitis was diagnosed preoperatively. At laparotomy in emergency surgery we found inflamed appendix epiploica on the ascending colon and adhering to the mesenterium, leading to small bowel obstruction. The obstruction was relieved by lysis of adhesions. The involved appendage was excised and the stump inverted because a diverticulum was found within the appendage. Appendectomy was performed. Pathologycally, there was no inflammation in the appendix or diverticulum, therefore, we diagnosed primary epiploic appendagitis. We review 56 patients with epiploic appendagitis in the Japan literature.

Key words
primary epiploic appendagitis, small bowel obstruction, CT

Reprint requests
Tomoaki Takada Department of Surgery, Yoichi Kyokai Hospital 85 Kurokawa-cho, Yoichi-cho, Yoichi-gun Hokkaido, 046-0003 JAPAN

Accepted
April 25, 2001

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