Virginia Research Day 2025

Medical Student Research Case Reports

02 Epiploic Appendagitis in a Young Adult Female: A Rare Cause of Acute Abdominal Pain

By: Paige O’Brien Daly, MA¹; Kaylie Ward¹; Brian Ho, MD²; Joy Elliott, DO² Corresponding author: pdaly@vcom.edu

¹ Edward Via College of Osteopathic Medicine - Virginia Campus ² Riverside Family Medicine at the Brentwood Medical Center, Newport News, VA

Background: Epiploic appendagitis (EA) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. It typically affects middle aged males and results from inflammation of the epiploic appendages, small fat-filled sacs protruding from the colon's serosal surface. EA often mimics more serious conditions such as diverticulitis or appendicitis, leading to diagnostic challenges and potential overtreatment. The condition accounts for approximately 1% of acute abdominal pain cases in adults and 2% of cases initially diagnosed as acute appendicitis or diverticulitis. Increased awareness of EA across diverse patient demographics is crucial for improving diagnostic accuracy and optimizing patient care.

Case Summary: A 32-year-old Hispanic female presented to the emergency department with a 3-day history of progressive left lower quadrant abdominal pain, accompanied by mild nausea and diarrhea. Initial suspicion was for diverticulitis or infectious colitis. However, contrast-enhanced CT imaging revealed characteristic findings of EA, including an oval fatty mass with a hyperattenuated ring sign adjacent to the proximal sigmoid colon. This diagnosis was particularly noteworthy due to the patient's atypical demographic for EA. Conservative management with anti-inflammatory medications and pain control was initiated, leading to significant symptom improvement. The patient was successfully treated without surgical intervention and discharged with outpatient follow-up instructions.

Conclusion: This case highlights the importance of considering EA in the differential diagnosis of acute abdominal pain across diverse patient demographics, including young adult females. It underscores the crucial role of contrast enhanced CT imaging in accurately diagnosing EA and differentiating it from more common acute abdominal conditions. By increasing awareness of EA among clinicians, we can improve diagnostic accuracy, reduce unnecessary interventions, and optimize patient care in cases of acute abdominal pain. Future research should focus on developing clinical prediction models, investigating risk factors across diverse populations, and assessing the cost

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