Surgical discovery: A rare case of strangulated epiploic appendage.

Rare Case: When a Hernia Isn't What It Seems

Theo Raines in Health & Wellness December 2025 • 4 min read.

"A 71-year-old's acute abdomen led doctors to a surprising discovery, highlighting the challenges of diagnosing unusual hernias."

When you think of a hernia, you probably picture a loop of intestine poking through a weak spot in your abdominal wall. While that's often the case, the human body loves to keep us on our toes. Sometimes, what seems like a typical hernia turns out to be something far more unusual.

Epiploic appendices (EA) are small, fat-filled sacs that hang off the colon. They're usually harmless, but when they become inflamed or twisted, they can cause a lot of pain. And, in very rare cases, they can even get trapped inside a hernia.

A recent case report details one such instance, where a 71-year-old man presented with symptoms suggesting a strangulated inguinal hernia. However, what surgeons found during the operation was a surprise: a hypertrophied (enlarged) epiploic appendage, strangulated within the hernia sac. This is the first documented case of its kind, presenting as an acute abdomen.

The Case Unfolds: A Twist in the Hernia Story

Surgical discovery: A rare case of strangulated epiploic appendage.

The 71-year-old patient arrived at the emergency department with intense pain, redness, and a noticeable mass in his left inguinal region and scrotum. These symptoms had appeared suddenly after a bout of sneezing and persisted for about 24 hours. The size of the hernia made the General Practitioner not try and reduce the mass.

Adding to the concern, the patient's C-reactive protein (CRP) levels were elevated, indicating inflammation. Attempts to reduce the hernia were unsuccessful, raising suspicion of bowel strangulation. As a result, the decision was made to proceed directly to surgery without further imaging.

Symptoms: Pain, redness, mass in the groin/scrotum
Cause: Developed after sneezing
Key Finding: Elevated CRP levels (inflammation)
Suspicion: Possible bowel strangulation

During the operation, surgeons made an incision parallel to the inguinal ligament. Upon exploring the mass, a rubbery, solid mass originating from the abdomen was found. Further investigation revealed that this mass was, in fact, a hypertrophied epiploic appendage that had become trapped and strangulated within the hernia. The surgeons then removed the mass and performed a standard hernia repair (Lichtenstein technique).

Lessons Learned: Thinking Outside the (Hernia) Box

This unusual case highlights the importance of considering rare conditions when diagnosing abdominal pain and hernias. While bowel strangulation is a serious concern, other possibilities, such as a strangulated epiploic appendage, should be kept in mind.

The case also underscores the role of surgical intervention in confirming diagnoses and providing treatment. In this instance, proceeding directly to surgery allowed for a definitive diagnosis and prompt resolution of the patient's condition.

While imaging techniques like ultrasound and CT scans can be helpful in diagnosing epiploic appendagitis, they shouldn't delay surgery if there's a strong suspicion of strangulation. As this case demonstrates, sometimes the best way to know for sure is to take a look inside.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.ijso.2018.08.004, Alternate LINK

Title: Hypertrophied Appendix Epiploica Strangulated In Inguinal Canal Presenting As Acute Abdomen: A Case Report

Subject: Surgery

Journal: International Journal of Surgery Open

Publisher: Elsevier BV

Authors: Thien Vinh Luong, Alaa El-Hussuna

Published: 2018-01-01

Everything You Need To Know

What is a hypertrophied epiploic appendage and how did it relate to this case?

A hypertrophied epiploic appendage, which is an enlarged fat-filled sac attached to the colon, can cause significant abdominal pain when it becomes trapped and strangulated within a hernia. The case presented highlights this unusual occurrence, demonstrating that hernias aren't always what they seem and can involve structures other than the bowel. The patient experienced acute abdomen, due to this rare condition, leading to surgical intervention.

What is an inguinal hernia, and how did this case differ from a typical one?

Inguinal hernias, typically involve a loop of intestine protruding through a weak spot in the abdominal wall. However, the presented case showed a different cause. Instead of the bowel, the hernia contained a strangulated epiploic appendage. This specific case underscores the importance of considering atypical causes of abdominal distress and the need for thorough investigation during diagnosis. The patient's case was further complicated by an unsuccessful attempt at reduction, elevated CRP levels, and a noticeable mass in the inguinal region and scrotum.

What are epiploic appendages, and what happens when they cause problems?

Epiploic appendages (EA) are small, fat-filled sacs that hang off the colon. These structures are usually harmless. But in rare instances, like the one described, they can become inflamed, twisted, or trapped, leading to pain. When an EA gets trapped inside a hernia sac and strangulated, it cuts off the blood supply, causing severe pain and potential complications. The patient's hypertrophied epiploic appendage was the cause of acute abdomen.

What is the significance of elevated C-reactive protein (CRP) levels in this type of situation?

The C-reactive protein (CRP) levels were elevated in the patient's case, indicating inflammation. This is a critical finding because elevated CRP often suggests an inflammatory process within the body. In this instance, the elevated CRP level, along with the patient's other symptoms like pain and a mass, raised suspicion of bowel strangulation. This led doctors to proceed with surgery. High CRP levels can be a red flag, signaling a serious condition requiring immediate medical attention.

What were the key symptoms and findings in the patient's presentation?

The symptoms experienced by the patient included intense pain, redness, and a noticeable mass in the left inguinal region and scrotum. These symptoms appeared suddenly, following a bout of sneezing. The size of the hernia mass and the unsuccessful reduction attempts were cause for concern. These combined factors, along with elevated CRP levels, led the medical team to suspect a potentially serious condition, necessitating immediate surgical intervention to address the patient's acute abdominal distress. Surgery involved an incision parallel to the inguinal ligament, where the hypertrophied epiploic appendage was discovered and removed, followed by a standard hernia repair (Lichtenstein technique).