Cecal epiploic appendage torsion in children and its diagnostic difficulties: a case report and review of literature

TL;DR

A 12-year-old girl was misdiagnosed with appendicitis but had a rare cecal epiploic appendage torsion, highlighting diagnostic challenges in children.

Contribution

This case report emphasizes the need for advanced imaging to diagnose cecal epiploic appendage torsion in children.

Findings

Cecal epiploic appendage torsion was misdiagnosed as acute appendicitis preoperatively.

Magnetic resonance imaging or computed tomography is recommended for accurate diagnosis.

Ultrasound alone may not detect torsion if the vermiform appendix is uninflamed.

Abstract

The epiploic appendix is rarely found in the cecum of children as a cause of abdominal pain in children due to torsion or inflammation. The purpose of this study was to reveal the preoperative diagnostic difficulties of cecal epiploic appendix torsion in children. We present the case of a 12-year-old girl who was misdiagnosed preoperatively with acute appendicitis and who was found upon surgical exploration to have a torsion of pedunculated tumor-like mass in the cecum. The uninflamed vermiform appendix and torqued mass-like tumor in the cecum were removed. The mass was confirmed to be a hemorrhagic infraction of the epiploic appendix of the cecum due to torsion. Pediatric surgeons should consider more often magnetic resonance image or eventually computed tomography of the abdomen and pelvis as the best diagnostic tool for cecal epiploic appendix torsion, especially when ultrasound reveals a non-inflamed vermiform appendix to avoid unnecessary surgical exploration.

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