A 49-year-old man presented to the emergency department of Ghaem Hospital due to diffuse abdominal pain with a predominance of the left lower quadrant. His pain started about three days ago and had progressed since then. During the clinical examination, the patient said that the pain was not localized and that the pain's intensity was constantly increasing throughout the abdomen. The patient gives a history of musculoskeletal pain from several years ago treated by chiropractic moves. The patient mentions that his pain started after the last chiropractic exercise. His body temperature was 38.7 °C, blood pressure was \(135/78\) mmHg, heart rate was 87 beats/minute, and respiratory rate was 18 breaths/min.
During the clinical examination, the patient was conscious and pale. Examination of the head, neck, lungs, and heart was normal. On abdominal examination, the patient had no surgical scar, distension, and hernia. On touch, the abdomen was soft with generalized tenderness with a predominance of the left lower quadrant and a rebound tenderness with no guarding in this area region. The rectal examination was normal. The patient was admitted due to severe abdominal pain.
Chest and abdomen X-rays and laboratory tests were performed.
In the CBC tests, he had no leukocytosis, and his hemoglobin and platelet counts were normal. His creatinine was 1.4 mg/dl, urea was 42 mg/dl, blood sugar was 106 mg/dl, and amylase was 34 U/L; hematology-CBC, hormone, and ABG tests were normal.
No specific findings have been reported on the posterior-anterior chest and the abdomen supine X-ray scans (Fig. 1.). No abnormal findings were reported on ultrasound. Due to his diagnosis's uncertainty, abdominal and pelvic CT scans (Fig. 2.) were also performed with and without oral and injectable contrast. CT scan showed mesenteric fat stranding in the distal descending colon. Differential diagnoses of acute cholecystitis, mesenteric ischemia, and colon appendix epiploic torsion were presented, and according to the clinical examination and test results, we considered colon appendix epiploic torsion as the final diagnosis.
According to the CT scan, appendicular torsion of the colon appendix was suggested. Due to this diagnosis and the lack of progression of symptoms within 24 hours after admission, the decision was made for non-surgical treatment, including gastrointestinal rest, antibiotics, analgesics, and fluid therapy.
Within 48 hours, the patient's general condition improved. The patient continued treatment with the diet and was discharged from the hospital one day after starting the diet with complete abdominal symptoms recovery.
In the 7-months follow-up of the patient, no consequent complications were observed. All patient’s information remained confidential, and consent was obtained from the patient to report this case.