An unusual case of small bowel obstruction secondary to internal herniation of distal ileum through a rent between adhered inflamed vermiform appendix and appendices epiploicae

Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.

Torsion of caecal appendices epiploicae: mimicking acute appendicitis

Acute appendicitis is a common cause for pain in the right iliac fossa, which requires urgent surgical intervention. However, at the time of surgery, if the appendix is normal, the surgeon has to search for other causes of acute abdominal pain including rare etiologies, such as torsion of appendices epiploicae and subsequently its gangrene. We report the case of a 45 years old female who presented with right lower abdominal pain, rebound tenderness and guarding in right iliac fosse, with regular menstrual cycles and no urinary complaints. Investigation revealed leucocytosis and ultra-sonography abdomen was suggestive of an inflamed appendix in the right iliac fossa with free fluid. Intra-operatively, we found a normal appendix with gangrene of the appendices epiploicae which had undergone torsion. She underwent excision off appendices epiploicae with appendicectomy with uneventful post-operative period. Histopathology of the appendices was suggestive of congestion. Preoperative diagnosis of this condition is rarely made.

It is not Appendicitis! It is Appendicitis Epiploica, the Great Pretender

Appendicitis epiploica or epiploicae appendagitis, an uncommon cause of abdominal pain, is usually per-operatively diagnosed. The pedunculated fat-filled small pouches or appendices epiploicae on the serosal surface of the colon often become twisted and sometimes spontaneous thrombosis occurs. Such events lead to ischemia and inflammation at the base of the fatty lobes i.e., Appendicitis epiploicae. Symptoms include sharp localized pain in either iliac fossae and in some cases there is elevated temperature and white blood cell count. In a quarter of the patients there is rebound tenderness and very rarely nausea and vomiting, diarrhoea or constipation. This condition is more common among middle aged males and given its non-specific symptoms. It is usually confused with other more common conditions such as Meckel’s diverticulitis and appendicitis. Less than 8% of patients suspected of having appendicitis or diverticulitis are found to actually have appendicitis epiploicae. Here we report two extremely rare cases of appendicitis epiploica in Bangladesh. Journal of Surgical Sciences (2019) Vol. 23(2): 95-97

A Rare Case of Intestinal Obstruction from Internal Hernia through a Foramen Formed by Appendices Epiploicae – A Case Report and Review of Literature

BACKGROUND: Internal hernias are uncommon causes of acute abdomen and intestinal obstruction. Internal herniation due to appendices epiploicae is very rare with only six cases reported in the literature.CASE REPORT: We, herein, present the report of a 64-year-old female who presented with features of intestinal obstruction due to internal herniation of a loop of small intestine through an orifice formed by the fusion of two appendices epiploicae. The band was divided into release the entrapped loop of bowel.CONCLUSION: A high index of suspicion with prompt surgical intervention will improve outcome.

The Enigmatic Fallopian Tube: A More Common Cause of Catheter Malfunction than Previously Recognized

Successful performance of peritoneal dialysis (PD) depends on a properly functioning PD catheter. Catheter malfunction remains a significant cause of technique failure, especially early in the course of therapy. Common causes of catheter malfunction include catheter displacement, omental or bowel wrapping, and fibrin clots. Less commonly, various intraperitoneal structures have been reported to lead to obstruction, including appendices epiploicae of sigmoid colon and the fallopian tube. Peritoneal dialysis catheter blockage due to fimbriae of the fallopian tube is being recognized as an important cause of catheter malfunction in females due to the increasing availability of diagnostic laparoscopy. We report 5 episodes of catheter malfunction in 4 patients on PD from a single center as a result of obstruction by the fallopian tube.

Giant peritoneal loose bodies

Giant peritoneal loose bodies are rare lesions, originating from auto-amputated appendices epiploicae. They may cause urinary or gastrointestinal obstruction and, should the radiologist not be familiar with the entity, can potentially be confused with malignant or parasitic lesions.Familiarity with their characteristic computed tomographic features is essential to prevent unnecessary surgery in the asymptomatic patient. We present a case of a 70-year-old man diagnosed with two giant peritoneal loose bodies.

A Novel Technique for Laparoscopic Salvage of CAPD Catheter Malfunction and Migration: The Santosh-PGI Hanging Loop Technique

CAPD catheter malfunction is a common problem. Obstruction due to wrapping by appendices epiploicae of sigmoid colon has been rarely reported in literature. We report a case of CAPD catheter malfunction caused by catheter tip migration and obstruction by appendices epiploicae that was successfully managed by laparoscopic hanging loop technique. This case report highlights the ease with which epiplopexy can be performed and catheter tip migration can be prevented by this innovative laparoscopic procedure.