An uncommon cause of abdominal pain in a young man

A 38 year old man with a known testicular germ cell tumour presented with acute right sided abdominal pain but no other symptoms. Clinical examination showed positive Murphy’s sign. Laboratory investigations showed leucocytosis of 10.6×109 (reference range 4.0-9.0×109)/L and serum C reactive protein of 59 (0.2-9.1) mg/L. Serum liver enzymes were unremarkable. A computed tomography scan of his abdomen and pelvis was performed (fig 1). What abnormality does this scan show? Fig 1 (a) Axial and (b) coronal sections of contrast enhanced computed tomography scan of the abdomen and pelvis at the mid-ascending colon A tubular hypodense lesion surrounding a central linear hyperdensity adjacent to the ascending colon with surrounding inflammatory changes, suggestive of epiploic appendagitis …