Localized, dull abdominal pain in an otherwise asymptomatic woman

Isolated abdominal tenderness in the absence of other abnormal physical examination and laboratory findings eventually leads to diagnosis of a rare and benign condition as modeled in the following case study. A 52-year-old female presented to the urgent care clinic with a 1-day history of localized, left lower-quadrant abdominal pain. She described the pain as “dull” and reported that it worsened with movement, especially when she was seated. There was no fever, nausea, vomiting, diarrhea, constipation, or blood in her stools. She had no urinary frequency, dysuria, or hematuria. The patient was menopausal and had no vaginal pain, discharge, or abnormal vaginal bleeding. Despite the lack of other pertinent positive findings on her review of systems, she expressed growing concern regarding the unknown cause of her abdominal pain, the abruptness of onset, and the intensity of her current symptoms. While epiploic appendagitis (EA) is rare and self-limited, it should be considered in any patient with right or left lower-quadrant abdominal pain, focal point tenderness, and negative laboratory findings. Abdominal CT is the preferred imaging modality for the diagnosis of EA and may produce the only abnormal finding on diagnostic evaluation. Known as “the great mimicker,” EA often manifests in a manner similar to that of appendicitis and diverticulitis. If EA is recognized and treated appropriately, patients will likely avoid exposure to needless antibiotics, hospitalization, and surgery.

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