Case Report
IsberAdemaj1*, Fisnik Kurshuml
Abstract
Epiploic appendix are rarely found in the children’s cecum usually during surgical exploration. Very rarely cause acute abdominal pain due to their torsion or inflammation that according to their localization can mimic other causes of abdominal pain. Usually torsion or inflammation of epiploic appendages are found as cause of acute abdominal pain after 4th decade of life but very rare cause abdominal pain in children. Vast majority of their torsion occur in rectosigmoid colon, but rarely in cecum mimicking acute appendicitis as a most often cause of acute abdominal pain in children’s. The purpose of this study is to reveal preoperative diagnostic difficulties of cecal epiploic appendix torsion in children due to its confusion with other abdominal condition that cause acute abdominal pain in right lower quadrant. Main factors that lead to its misdiagnosis are its rarity in children, unusual symptoms, absence of specific laboratory and radiological characteristic. We present a case of a 12-year-old Kosovo Albanian girl misdiagnosed preoperatively as acute appendicitis and found upon surgical exploration to have torqued tumor like mass in cecum. Uninflamed vermiform appendix and torqued mas like tumor in the cecum were removed and after HP examination was confirmed to be hemorrhagic infraction of epiploic appendix of the cecum due to its torsion. Data of patients who have undergone appendectomy during 2000-2017 were collected retrospectively and this is first case reported in our clinic diagnosed as cecal epiploic appendage torsion. We also review the literature trying to find much accurate methods and informations for diagnosing this pathology preoperatively to avoid unnecessary operation. Pediatric surgeons should consider more often computed tomography examination of abdomen as a best diagnostic tool for cecal epiploic appendix torsion especially when ultrasound reveal non inflamed vermiform appendix associated with normal or markedly elevated WBC count, to avoid unnecessary surgical exploration.