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BACKGROUND Benign symmetric lipomatosis (BSL) was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888. At present, about 400 cases have been reported worldwide. Across these cases, surgical resection remains the recommended treatment. Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region, which concealed the signs of a right incarcerated femoral hernia. CASE SUMMARY A 69-year-old male patient was admitted to our hospital with “abdominal pain, abdominal distension, nausea-vomiting and difficult defecation for half a month”. Moreover, he had a mass in the right inguinal region for more than 10 years. An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later. In addition, the patient had a history of heavy alcohol consumption for more than 40 years. With the aid of computerized tomography scan, the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia. Under general anesthesia, right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed. However, this patient did not receive BSL resection. After a 1-year follow-up, no recurrence of the right inguinal femoral hernia was found. Moreover, no increase in fat accumulation was found in the neck or other areas. CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect, but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.

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A 38 year old man was admitted to our hospital with abdominal pain. He had an untreated right inguinal hernia and the hernia presented as a swelling ball of 4.0×3.0 cm in size. CT showed a large mass of fat density below the Sigmoid colon and incarcerated fat within the right inguinal hernia. Emergent laparotomy revealed four-circle twisted and infarcted greater omentum and a little bloody ascites within the right inguinal hernia. Pathological examination showed hemorrhagic infarction of the greater omentum. Although omental torsion is a rare cause of acute abdominal pain, it should be taken into consideration in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.

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