Can elongation of the ileum by epiploic appendagitis result in acute abdomen?

Epiploic appendagitis mimics acute abdomen or is a condition associated with acute abdomen, although it is usually not treated by emergent surgical intervention and has characteristic findings on computed tomography (1). Mechanical intestinal obstruction is not a real manifestation of the disease because those small appendages (inflamed or not) cannot easily obstruct the small or large intestines because of their small sizes. Epiploic or omental appendages are in fact visceral peritoneal pouches that arise from the serosal and antimesenteric surface of the large intestine. They may act as defending mechanisms, similar to the omentum (2). They can even be helpful in spontaneous healing of small perforations in the hollow viscera, and they can also be used as a patch during surgical interventions, such as in appendectomy, by the surgeon. Because of their roles in defending mechanisms, they can also be speculatively interpreted as dwarf omental structures. Consisting of fat tissue and vessels, they have a length of 0.5-5 cm. While epiploic appendages located near the sigmoid colon are the biggest, >100 such appendages may also occur. None of them are found at the rectal wall. Unfortunately, epiploic appendages are detected on computed tomography only when they are inflamed or surrounded by fluid accumulation. Torsion of epiploic appendages results in vascular occlusion that might lead to ischemia (3). Although there are rare reports about acute epiploic appendagitis, a condition resulting in mechanical obstruction of the ileum elongated like a horse by inflamed and fused epiploic appendagitis has not been reported previously.