Cecal epiploic appendage torsion in children and its diagnostic difficulties: a case report and review of literature

The epiploic appendix is rarely found in the cecum of children as a cause of abdominal pain in children due to torsion or inflammation. The purpose of this study was to reveal the preoperative diagnostic difficulties of cecal epiploic appendix torsion in children. We present the case of a 12-year-old girl who was misdiagnosed preoperatively with acute appendicitis and who was found upon surgical exploration to have a torsion of pedunculated tumor-like mass in the cecum. The uninflamed vermiform appendix and torqued mass-like tumor in the cecum were removed. The mass was confirmed to be a hemorrhagic infraction of the epiploic appendix of the cecum due to torsion. Pediatric surgeons should consider more often magnetic resonance image or eventually computed tomography of the abdomen and pelvis as the best diagnostic tool for cecal epiploic appendix torsion, especially when ultrasound reveals a non-inflamed vermiform appendix to avoid unnecessary surgical exploration.