Challenging differential diagnosis, Management of emergency care, Rare disease
Munzir Obaid, Salahddin Gehani
Department of General Surgery, Hamad Medical Corporation, Doha, Qatar
Am J Case Rep 2018; 19:854-857
Peritoneal loose bodies, also known as peritoneal mice, are rare findings and they present either with nonspecific symptoms or are found incidentally during exploration and autopsy. Usually, they have no clinical significance and require no specific treatment. We report a case of a giant peritoneal loose body found incidentally in the abdominal cavity of a patient who presented with abdominal pain and hematuria.
CASE REPORT: Our patient was a 58-year-old man who presented with abdominal pain and hematuria. Abdominal non-contrast computed tomography (CT) and subsequent CT abdomen and pelvis with intravenous and oral rectal contrast were performed preoperatively, showing a well-circumscribed and calcified lesion of undetermined etiology in the abdominal cavity. The lesion was removed laparoscopically with no complications. Histopathologically, the lesion was reported as calcified tissue with fat necrosis, most likely an infarcted appendix epiploicae.
CONCLUSIONS: Loose peritoneal bodies can present a challenging diagnostic problem to the surgeon, with confusing findings that can point towards malignancy. It often requires a number of investigations; however even with these investigations, operative exploration, either open or laparoscopic, can be the ultimate diagnostic and therapeutic modality, and the mobility of these calcified lesions may give a preoperative clue to the etiology. It is important to distinguish peritoneal loose bodies from neoplastic or metastatic lesions and to consider it in the differential diagnosis of a calcified mobile pelvic mass. Laparoscopic surgery is safe and effective in the retrieval of symptomatic peritoneal loose bodies.
Keywords: Boiled Egg, Hematuria, Appendices Epiploicae, laparoscopic surgery, Peritoneal Loose Body