Symptomatic giant peritoneal loose body in the pelvic cavity: A case report

Abstract

Introduction: Giant peritoneal loose bodies (gPLB) occur rarely and therefore only few have been described. Often they are found incidentally and have no clinical relevance, whereas symptomatic forms may require surgical removal.

Presentation of case: We report the case of a male patient suffering from abdominal discomfort with alternating localizations for several years, actually presenting with a proctitis. With elevated inflammatory markers, a conspicuous resistance in the lower abdomen and in order to evaluate further affection of the colon, an abdominal CT-scan was performed. It revealed a spherical mass in the lesser pelvis. A colonoscopy confirmed the proctitis, showing no further pathologies. Due to the symptoms and the uncertain entity of the mass, a diagnostic laparoscopy was performed and a boiled egg-like structure (diameter 5.2cm) was removed. The patient recovered well and was free of symptoms.

Discussion: The patient had two potential reasons for his symptoms, one of them being a suspected leftover foreign body years after an appendectomy. The proctitis was treated conservatively but without complete remission of the abdominal discomfort. Therefore, a diagnostic laparoscopy was performed and the mass turned out to be a gPLB.

Conclusion: To obtain a fast diagnosis and to perform an adequate conservative or surgical therapy, the knowledge about the rare entity of a gPLB is necessary. An exact anamnesis, clinical examination and the knowledge about the diagnostic values of radiological and endoscopic investigations are crucial.

Keywords: Appendices epiploicae; Boiled egg; Giant peritoneal loose body; Laparoscopic surgery.

Fig. 1

CT-scan (coronal plane) showing a spherical mass (arrow) in the true pelvis with central calcifications, surrounded by soft tissue and lacking obvious connection to other organs.

Fig. 2

Intraoperative view during laparoscopy showing the freely floating, glistering gPLB in the lesser pelvis.

Fig. 3

gPLB after extraction from the abdominal cavity, measuring 5.2 × 4.5 × 4.2 cm with a white, shiny surface.

Fig. 4

Cross section of the gPLB after longitudinal slice (a) and nucleus (b): the outer layers were yellow to white, homogenous and had a lamellar, rubber-like texture. The calcified nucleus had a very hard consistency.

Fig. 5

Histological examination: the histology showed a calcified necrosis of fat tissue (nucleus) with hypocellular fibrolamellar tissue with numerous microcalcifications (outer layers).