Acute abdomen is the most common emergency surgical presentation, often caused by small bowel obstruction (SBO). There are many underlying causes of SBO, of which post-operative adhesions are the commonest. Acute epiploic appendagitis is a rare cause of SBO with only a few reported cases in the literature. We report a rare case of SBO secondary to sigmoid appendagitis presenting with colicky epigastric pain and delayed onset obstructive symptoms (intractable vomiting and constipation).

We chose to highlight this case given the unusual presentation and diagnostic dilemma, particularly the unusual localisation of pain. In addition, we wanted to highlight the laparoscopic management of this case, as opposed to laparotomy (described in the literature), which minimised surgical morbidity for the patient.