THE UNEXPECTED VILLAIN: A CASE OF ACUTE EPIPLOIC APPENDAGITIS IN A YOUNG MALE WITH ACUTE ABDOMEN Edna Sarpong, Vaishnavi Singh, Het Patel, Anand Desai; Willis-Knighton Medical Center, Shreveport, LA.
Introduction: Acute epiploic appendagitis (AEA) is a rare, self-limiting inflammatory condition of the epiploic appendages, small fat-filled outpouchings along the colon. While often overlooked as a differential diagnosis, AEA can mimic more common causes of acute abdominal pain, such as appendicitis and diverticulitis. Typically presenting with localized pain and without systemic symptoms, AEA is diagnosed primarily through imaging, with CT scans showing fat stranding around the affected appendage. Case: A 21-year-old male presented with a three- day history of abdominal pain localized to the left iliac fossa. He reported the pain exacerbated with movements such as coughing, laughing and urination. He rated it at 4/10 at its worst and 2/10 at its best. He denied having nausea, vomiting, diarrhea, constipation, fever, and chills. His physical examination and laboratory findings were unremarkable. Initial CT imaging revealed AEA of the sigmoid colon. Conservative management was initiated with intravenous fluids, analgesics, and antibiotics (ciprofloxacin
and metronidazole). However, his pain worsened over the next two days, spreading to the right iliac fossa, though he remained afebrile and without additional symptoms. A repeat CT scan showed no progression of AEA but given his increasing symptoms and the development of rebound tenderness, General Surgery was consulted. Patient underwent a diagnostic laparoscopy which revealed an inflamed epiploic appendage of the sigmoid colon adherent to the anterior abdominal wall, which was subsequently resected. His recovery was uneventful, and he was discharged on the fourth day. Discussion: The exact incidence of epiploic appendagitis is unknown, but it is reported in 2% to 7% of patients initially suspected of acute diverticulitis and in 0.3% to 1% of those suspected of acute appendicitis. Our case reflects the typical presentation of AEA in young males with acute left abdominal pain. Clinicians must consider AEA as a differential diagnosis for acute abdominal pain. Timely recognition and appropriate intervention can prevent complications and reduce financial burdens.
EXPLORING METASTATIC PATHWAYS: NEUROENDOCRINE CARCINOMA OF THE LUNG WITH LIVER AND ADRENAL GLAND INVOLVEMENT.
Erica Jones, Jacob Cunningham, Archa Rajesh, Sri Pranvi Boyapati, Karen Curry; Louisiana State University Health Sciences Center at Ochsner University Hospital & Clinics, Department of Internal Medicine, Lafayette, LA.
Introduction: Neuroendocrine tumors (NETs) are composed of a unique class of neoplasms derived from endocrine and nervous systems. The subtypes represent a wide range of clinical presentations, from incidental findings to devastating metastatic disease. Neuroendocrine carcinomas (NECs) are poorly differentiated high- grade NETs, the most aggressive subtype. Case: A 61-year-old male with a history of tobacco use presented with abdominal pain, nausea, dyspnea, and a 9-month history of unexplained weight loss, after a recent diagnosis of carcinoma of unknown primary with liver metastases three weeks prior. The patient was referred to Surgical Oncology, and initial
tests showed marked elevation of CEA, CA 125, and CA 19-9. A CT scan revealed hepatomegaly, hepatic lesions, bilateral adrenal masses, and enlarged lymph nodes. On presentation, he was tachycardic and hypoxic. A CT chest angiogram ruled out pulmonary embolism but showed a left hilar mass obstructing the left upper lobe bronchus, causing complete collapse. He stabilized with analgesics and was discharged with an appointment for a liver biopsy two days later. One week later, he was admitted with acute pancreatitis. Oncology reviewed the liver biopsy, which had insufficient cellularity, but suggested extensive stage small cell lung cancer versus large cell neuroendocrine carcinoma. A repeat biopsy was recommended prior to initiating 12
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