Primary epiploic appendagitis: a rare cause of localised abdominal pain

SUMMARY Primary epiploic appendagitis (PEA) is a rare cause of abdominal pain due to inflammation of the epiploic appendages protruding from the serosal surface of the colon. As symptoms other than localised abdominal pain may be absent and blood test results are non-specific, imaging is key to the diagnosis. We describe a case of PEA that was diagnosed based on the characteristic CT findings in a man with a history of somatic symptom disorder (SSD). A man in his 40s visited the outpatient clinic with a 3-day history of left lower abdominal pain. He had a history of hyperlipidaemia and SSD for the past 5 years and was taking oral medications (pitavastatin calcium for hyperlipidaemia, and escitalopram oxalate and etizolam for anxiety) but had not taken any analgesics. He had no history of complications of surgery, prior infection, trauma or travel. He had no fever, loss of appetite, nausea, vomiting, constipation, diarrhoea or radiating pain. His body temperature, blood pressure and heart rate were 37.0°C, 136/84 mm Hg and 88 beats per minute, respectively. He was overweight (Body Mass Index: 28.0 kg/m2). Physical examination of the abdomen revealed lower abdominal distension in the standing position but no protrusion of the umbilicus and no percussion findings suggestive of ascites or flatulence. There were no increased or decreased bowel sounds on auscultation, suggesting that bowel peristalsis was normal, and the patient’s belly was bulging due to fat. © 2024 BMJ Publishing Group. All rights reserved.