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Liposarcoma is one of the most common soft tissue sarcomas and has multiple subtypes, including atypical, well-differentiated, and dedifferentiated liposarcoma1. These tumors most commonly occur in the extremities and the retroperitoneum2, and account for 20% of all retroperitoneal tumors3. Retroperitoneal liposarcoma is very rare overall, occurring in 2.5 per one million people4. Patients will present from symptoms of mass effect due to the uncontrolled growth in the large potential space of the retroperitoneum, with its median size being around 30 cm5. The mainstay of treatment for this type of tumor is resection to a negative margin6. This is a case report describing a retroperitoneal liposarcoma presenting with bilateral inguinal hernias containing intraperitoneal fat from mass effect.

Background: The SARS-CoV-2 virus has caused patient aversion to health care facilities for fear of contracting the virus. It has been shown that there has been a decreased amount of emergency department visits since the pandemic started1, with an increased presentation of conditions with progressed pathology. At our community hospital, it was anecdotally noted that there was an increase in the number of patients presenting with perforated appendicitis during this time. Our hypothesis is that more patients presented with the progressed finding of perforated appendicitis during rather than prior to the pandemic because of fear of exposure to COVID-19 in the health care setting. Methods: Retrospective chart review of cases of perforated appendicitis at a local community hospital during March 10-December 31, 2019 (cohort A) and March 10-December 31, 2020 (cohort B).Results: A total of three hundred and fifty-two eligible patients received treatment for acute appendicitis at our community hospital. In Cohort A (prior to the pandemic), there were 53 perforations out of 188 patients (53/188) - 28.2%. In cohort B (during the pandemic), there was 61 perforations out of 164 patients (61/164) – 37.2%. Statistically, there was no difference in the rate of perforation between Cohort A and Cohort B, approaching significance (p-value = 0.072). The median age of patients in Cohort A was 38 and in Cohort B it was 43.5 years of age. There was no statistically significant differences between cohorts regarding age (p < 0.23) and sex (p < 0.8). Conclusion: This study found that the number of patients who presented with perforated appendicitis during the pandemic did increase compared to pre-pandemic (37.2% vs 28.2%) but this did not meet statistical significance (p=0.072).