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BEYOND TERMINAL ILEITIS: A CASE REPORT OF EPIPLOIC APPENDAGITIS HIGHLIGHTING THE ROLE OF MULTIDISCIPLINARY APPROCH AGAINST MISLEADING ELEMENTS

Carlo Maria Maino 1, Flavio Caprioli 2, Luisa Spina 3, Francesca Chiaraviglio 4, Vera Burghignoli 4, Matteo Prati 5, Andrea Costantino 3, Francesco Conforti 3, Maurizio Vecchi 2

Affiliations

1 University of Milan, Milan, Italy

2 University of Milan, Milano, Italy|||Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy

3 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy

4 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

5 Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy

Summary

AI Generated

A 32-year-old man with right lower quadrant pain and elevated fecal calprotectin was ultimately diagnosed with epiploic appendagitis after IBD was excluded through normal endoscopy and histology.

Initial imaging showed terminal ileum wall thickening and mesenteric fat stranding with normal appendix, raising suspicion for inflammatory bowel disease alongside elevated fecal calprotectin.
Colonoscopy to the terminal ileum revealed normal mucosa and biopsies were histologically unremarkable, with negative microbiological tests.
Empirical antibiotic therapy with ciprofloxacin and metronidazole led to rapid clinical improvement and complete remission after one week.
A multidisciplinary team diagnosed epiploic appendagitis based on localized pain, imaging showing a fatty lesion near the cecal serosa, and favorable treatment response, ruling out IBD.
The case demonstrates that epiploic appendagitis can mimic IBD presentation and that multidisciplinary evaluation is essential for identifying less common diagnoses in ambiguous clinical scenarios.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Clinical Case Summary

Background and aim: We report the case of a 32-year-old North African man with no significant medical history, presenting with a two-day history of right lower quadrant abdominal pain.
Material and methods: Physical exam revealed localized tenderness with mild guarding, without peritonitis. Blood tests showed elevated C-reactive protein, but clinical scores suggested low likelihood of appendicitis. Ultrasound showed fatty infiltration near the cecum and reactive lymph nodes. A CT scan revealed terminal ileum wall thickening and mesenteric fat stranding anterolateral to the cecum, with a normal appendix. Elevated fecal calprotectin and imaging findings raised suspicion of inflammatory bowel disease (IBD). Colonoscopy up to the terminal ileum showed normal mucosa, and biopsies were histologically unremarkable. Microbiological tests were negative. Empirical antibiotic therapy with ciprofloxacin and metronidazole led to rapid clinical and biochemical improvement.
Results: After one week of antibiotics, the patient achieved complete remission. Follow-up CT enterography showed persistent perivisceral fat thickening without enhancement, suggesting a necrotic focus near the cecum, with normal-appearing distal ileum. A multidisciplinary team including gastroenterologists, radiologists, and surgeons concluded the most likely diagnosis was epiploic appendagitis, based on localized pain, imaging showing a fatty lesion near the cecal serosa, and the favorable response to treatment. IBD, including Crohn’s disease, was ruled out due to the absence of supporting endoscopic, histologic, or radiologic findings. Terminal ileum thickening was considered reactive, and elevated calprotectin interpreted as a nonspecific marker.
Conclusions: This case illustrates how epiploic appendagitis can mimic the presentation of IBD. In such ambiguous scenarios, a multidisciplinary approach is essential to explore less common differential diagnoses.

References

Image 1: contrast enhanced abdominal CT scan. Increased thickness of the terminal ileal mucosa and edema of the mesenteric fat anterolateral to the cecum, with a normal appendix.

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

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… after ileocecal resection of localised Crohn's disease

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