A rare case of appendicitis-like syndrome: Prompt laparoscopic diagnosis and management

Background Torsion/necrosis of peduncolated tumors represent a rare cause of acute abdomen, potentially mimicking other conditions, such as acute appencitis. Owing to rarity, symptoms’ aspecificity and difficult interpretation of imagery, diagnosis is difficult to achieve preoperatively and surgery may be challenging. Laparoscopy has been proposed in recent years for diagnosis/management of several conditions in an emergency setting. Objectives To describe a case of a patient affected by an ischemic ileal hemangioma mimicking an acute appendicitis and managed laparoscopically. Case report A 16-y-old boy was admitted with an appendicitis-like syndrome (hyperpyrexia, right iliac fossa pain and tenderness). Peri-operative CT scan showed a 3-cm-image which was interpreted as a peri-appendicular abscess. At laparoscopy, a twisted, ischemic mass adherent to the surrounding ileum, was found and removed. Outcome was uneventful. Pathology showed a benign hemangioma of the ileal mesentery. This is the first case treated by laparoscopic resection (video). Conclusion Laparoscopy allowed achieving a diagnosis and performing the appropriate treatment, without the need of a second laparotomy. Rare causes of acute abdomen represent an argument in favor of a laparoscopic approach to patients with suspected acute appendicitis.