Asymptomatic epiploic appendage with torsion in laparoscopic surgery: a case report and literature review.

Torsion of an epiploic appendage may result in epiploic appendagitis, which is a rare cause of acute abdominal pain. However, no previous reports have described an asymptomatic twisted epiploic appendage found during laparoscopaic surgery to the best of our knowledge. This case describes a 66-year-old man who was admitted to our medical center with yellowness of the skin and eyes that had lasted over two months. Physical examination showed slight yellow staining of the skin and sclera. Blood analysis indicated liver dysfunction and jaundice. Routine blood, C-reactive protein (CRP), and levels of tumor markers were normal. The contrast-enhanced abdominal and pelvic computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography revealed gallbladder atrophy and choledocholithiasis. The patient underwent laparoscopic surgery for the removal of the choledocholithiasis. The laparoscopic exploration unexpectedly revealed a twisted and ischemic epiploic appendage, which was surgically removed. The postoperative pathological examination uncovered necrosis of adipocytes and vascular obstruction, but there was no inflammation of the epiploic appendage. The patient had a satisfactory recovery during the 16-month follow-up period. This case describes and provides a feasible management approach for an asymptomatic twisted epiploic appendage discovered during surgery and highlights its pathological characteristics, reflecting the early stage of epiploic appendagitis.