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Acute epiploic appendagitis is an uncommon cause of abdominal pain. It is caused by torsion of an epiploic appendage or spontaneous venous thrombosis of a draining appendageal vein.1 The diagnosis of this condition primarily relies on cross-sectional imaging and is made most often after computed tomography (CT). Clinically, it is most often mistaken for acute diverticulitis. Approximately 7.1% of patients investigated to exclude sigmoid diverticulitis have imaging findings of primary epiploic appendagitis.2
A 20-year-old man presented to the emergency department with constant sharp pain in the left iliac fossa. Vital signs and abdominal examination were unremarkable. He was discharged with simple analgesic medication because the pain appeared to improve. However, he re-presented to the emergency department within 24 h of discharge, with constant pain, tenderness …