Omental infarction (OI) is a rare cause of acute abdominal pain that often mimics common surgical emergencies such as appendicitis. Due to its nonspecific presentation, the diagnosis is frequently delayed or missed. We report the case of a 43-year-old man who presented with right lower quadrant abdominal pain and was initially suspected to have appendicitis. Contrast-enhanced computed tomography (CT) revealed findings consistent with primary OI. The patient was managed conservatively with analgesics and anti-inflammatory medications, resulting in complete symptom resolution within one week. This case highlights the importance of considering OI in patients presenting with localized abdominal pain and normal laboratory findings, as early radiologic diagnosis allows for conservative management and the avoidance of unnecessary surgical intervention.

Chronic appendicitis is a common cause of recurrent right lower quadrant pain and is often difficult to diagnose because of its nonspecific presentation. Pneumatosis cystoides intestinalis (PCI), a rare condition characterized by gas-filled cysts in the intestinal wall, is usually associated with other gastrointestinal disorders. We report a 43-year-old woman with a one-year history of intermittent abdominal discomfort who was found to have chronic appendicitis with concurrent PCI, an unusual combination that created diagnostic uncertainty. Computed tomography revealed gas in the appendiceal region and adjacent bowel wall. Colonoscopy and laparoscopic appendectomy were subsequently performed, excluding other gastrointestinal lesions and confirming chronic appendicitis on histopathology. The patient recovered well after surgery, and follow-up imaging 6 months later showed complete resolution of PCI. This report contributes valuable insights into the complex relationship between chronic appendicitis and PCI. Awareness of this association may help improve diagnosis and management.

BACKGROUND Solitary neurofibromas of the colon are extremely rare and are most often reported in patients with neurofibromatosis type 1 (NF1). Although usually benign, these lesions can rarely undergo malignant transformation, particularly when associated with NF1. Therefore, isolated cases merit careful evaluation and follow-up. CASE REPORT A man in his 70s with a history of benign prostatic hyperplasia presented with recurrent abdominal pain, constipation, and unintentional weight loss of 5 kg over 1 month. Physical examination revealed a firm, non-mobile mass in the right lower quadrant, with no other systemic findings or features suggestive of NF1. Laboratory investigations were within normal limits except for mildly elevated lactate dehydrogenase, while carcinoembryonic antigen was normal. Computed tomography and magnetic resonance imaging demonstrated a cystic lesion arising at the base of the appendix and protruding into the cecum. Colonoscopy revealed a large, smooth polypoid mass, and biopsy showed a spindle-cell lesion of neurogenic origin. The patient underwent an open right hemicolectomy with primary ileocolic anastomosis, due to persistent symptoms and concern for potential complications. Final histopathology confirmed a benign isolated colonic neurofibroma with negative resection margins and a reactive mesocolic lymph node, with no evidence of malignancy. The postoperative course was uneventful. The patient remained asymptomatic, with no recurrence during more than 3 years of follow-up. CONCLUSIONS This case highlights that isolated colonic neurofibroma should be included in the differential diagnosis of nonspecific or submucosal colonic masses. Long-term follow-up is important to monitor for local recurrence, possible malignant transformation, and the later appearance of NF1 features.

Inflammatory myofibroblastic tumor (IMT) of the colon is a rare mesenchymal neoplasm of intermediate biological potential that can mimic acute appendicitis in adolescents. We report a 13-year-old male presenting with right lower quadrant pain and fever. Initial ultrasound revealed a large heterogeneous hypoechoic mass. Contrast-enhanced ultrasound (CEUS) clearly differentiated a peripherally enhancing viable rim from a central necrotic area, enabling precise ultrasound-guided core needle biopsy that yielded a definitive preoperative diagnosis of IMT. The patient underwent laparoscopic right hemicolectomy with negative margins and had an uneventful recovery. This case illustrates that a systematic CEUS-guided biopsy approach is safe and accurate, allowing targeted sampling of viable tissue and guiding appropriate surgical resection. Recognizing the diagnostic value of CEUS in complex pediatric abdominal masses may help avoid misdiagnosis and unnecessary extensive surgery.

We report the case of a 32-year-old man with congenital adrenal hyperplasia on chronic dexamethasone and fludrocortisone therapy who presented with nausea, diarrhea, and a single episode of vomiting, while denying abdominal pain, fever, anorexia, or right lower quadrant discomfort. Physical examination revealed a completely benign abdomen without tenderness, guarding, rebound, or peritoneal signs. Laboratory evaluation demonstrated hyponatremia and acute kidney injury without leukocytosis. Despite an Alvarado score of 1, CT imaging of the abdomen revealed acute appendicitis, which was later confirmed intraoperatively as a non-perforated, inflamed appendix. This case demonstrates an atypical presentation of acute appendicitis characterized by a benign abdominal examination and normal inflammatory markers in the setting of chronic glucocorticoid therapy. It highlights the importance of maintaining diagnostic vigilance and considering early imaging in steroid-dependent patients with persistent gastrointestinal symptoms, even in the absence of classic clinical findings.

Acute appendicitis is one of the most common causes of right lower quadrant (RLQ) abdominal pain, and appendectomy remains the standard treatment. However, residual appendiceal tissue may persist after surgery and subsequently become inflamed, resulting in stump appendicitis, a rare but clinically significant condition. This review summarizes the current literature on stump appendicitis from 2000 to 2025, focusing on pathophysiology, clinical presentation, diagnostic modalities, and management strategies. A comprehensive search of PubMed, Google Scholar, and Cochrane databases was performed, and relevant English-language studies were analyzed. Reported cases span a wide age range, with variable intervals between index appendectomy and presentation. Most patients present with RLQ pain and imaging findings consistent with appendiceal inflammation, although diagnosis is often delayed due to low clinical suspicion. Computed tomography remains the diagnostic modality of choice. Management is typically completion appendectomy; however, selected uncomplicated cases may be initially managed conservatively with antibiotics, with or without interval surgery. Complicated cases may require percutaneous drainage or more extensive resection. Stump appendicitis remains under-recognized, and greater awareness, standardized reporting, and prospective studies are needed to improve diagnosis and guide management.

Appendiceal mucinous neoplasms are rare entities that account for a small proportion of all gastrointestinal malignancies and are most often discovered incidentally on histopathological examination of appendectomy specimens. We present the case of a 36-year-old woman who presented to the emergency department with acute right lower quadrant abdominal pain and was found to have acute appendicitis on computed tomography imaging. She underwent an uncomplicated laparoscopic appendectomy, and final pathology revealed a low-grade appendiceal mucinous neoplasm (LAMN) confined to the appendix, staged as pTis(LAMN). Postoperative colonoscopy was performed to evaluate the appendiceal orifice and exclude synchronous colorectal lesions. This case highlights the importance of routine histopathological examination of all appendectomy specimens and the need for appropriate postoperative surveillance in patients with incidentally discovered appendiceal mucinous neoplasms.

Hereditary angioedema (HAE) due to C1 esterase inhibitor (C1-INH) deficiency is a rare bradykinin-mediated disease characterized by recurrent episodes of angioedema. Gastrointestinal manifestations can resemble an acute abdomen and are often misdiagnosed, contributing to delayed recognition. We describe a 35-year-old man with two previous self-limited episodes of abdominal pain with diarrhea over the preceding year, beginning in August 2024, each lasting approximately five days, both of which were diagnosed as acute gastroenteritis and treated with symptomatic intravenous therapy. He presented with acute paroxysmal right lower quadrant abdominal pain and watery diarrhea, without fever, nausea, or vomiting. Contrast-enhanced abdominal computed tomography revealed segmental ileal wall edema with ascites, showing slight progression on repeat imaging later the same day. Laboratory analysis demonstrated leukocytosis with neutrophilia and significantly elevated D-dimer levels. Complement testing showed a significantly reduced C4 concentration (0.08 g/L) and a normal C3 level (0.84 g/L), raising suspicion of HAE. Further evaluation confirmed profoundly decreased functional C1-INH activity (<7%) and a reduced C1-INH antigen level (18.89 μg/mL), establishing a diagnosis of type I HAE. The patient improved following supportive and antispasmodic treatment, and no HAE-specific bradykinin-targeted therapy was administered during this admission. This case emphasizes that recurrent, self-limited abdominal pain accompanied by imaging evidence of transient small-bowel wall edema and ascites should prompt consideration of abdominal HAE. Early assessment of complement C4 is a practical screening strategy that enables timely confirmatory testing and minimizes the likelihood of repeated misdiagnosis.