Hypertrophied appendix epiploica strangulated in inguinal canal presenting as acute abdomen: A case report

Introduction: Different illnesses can affect the Epiploic Appendices (EA) of the Colon. Strangulation of the EA has previously been described inside a hernia sack associated with bowel herniation, but it is rarely presented as the only entity. This is the first case where a hypertrophied EA presented as acute abdomen mimicking a strangulated inguinal hernia. Presentation of the case: We present a case of a 71-year-old male who was admitted to the emergency department with acute pain around the left inguinal area. A firm mass measuring 5 × 6 cm had appeared sneezing, and had persisted for 24 hours with no nausea or vomiting. The patient had normal bowel motion on the same day. The hernia was not reducible. Because of suspicion of bowel strangulation inside the hernia sack, acute surgical intervention was performed. A hypertrophied EA was found in the hernia sack and treated with open herniotomy. The postoperative period was uneventful and the patient was discharged in good health four days following the operation. Discussion: Epiploic appendagitis caused by inflammation or strangulation can mimic other causes of acute abdomen but often presents a less severe clinical picture. The patient suffered from a strangulated hernia containing a hypertrophic EA. To our knowledge, this is the first case report of a hypertrophied EA inside an inguinal hernia requiring immediate operation. Conclusion: Hypertrophied EA can mimic a strangulated hernia. High index of suspicion is needed to diagnose this rare condition. Surgical intervention can both confirm the diagnosis and treat the condition.