Deciding to Remove or Leave a Peritoneal Loose Body: A Case Report and Review of Literature

Abstract

Patient: Male, 58Final Diagnosis: Peritoneal loose bodySymptoms: Abdominal pain • hematuriaMedication: —Clinical Procedure: Diagnostic laparoscopySpecialty: SurgeryObjective:Unusual clinical courseBackground: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.

Giant peritoneal loose body: A case report

“…However, in cases of giant PLBs, surgical intervention is important for treatment, as giant PLBs are more likely to cause acute or life-threatening symptoms (7). Furthermore, other diseases may not be fully excluded following radiological imaging alone so surgical exploration may be necessary for the definitive diagnosis and treatment of PLBs (8).…”

A rare peritoneal egg: Case report with literature review

“…Clinically, the gPLB can be asymptomatic and an accidental finding but can occasionally present with acute as well as chronic symptoms [5] , [6] , [7] as in our case. Among the previously reported cases, majority were men with mean age of 56.3 years (2 months to 79 years) and most commonly they presented with symptoms of pain abdomen and/or urinary frequency [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] . The mean size of loose body is 6.26 centimeter (range, 2.5-10.4 cm) [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] .…”

“…Many a times, these gPLBs are misinterpreted as intraabdominal tumors or foreign bodies and unnecessary surgical interventions are carried out [8] . However, surgical exploration may become imperative for definite diagnosis and treatment in some instances [9] .…”

Peritoneal loose bodies and the differentiation of fatty abdominal and pelvic lesions

“…Given the frequency of indeterminate differentials following imaging for PBLs, we focused on the development of a simple algorithm to identify these rare manifestations ( Fig. 5 ) [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . Based on the literature review, MRI early in the diagnostic pathway is beneficial.…”

“…Peritoneal loose bodies (PLBs) have been sparingly documented within the surgical and radiologic literature, with 38 cases reported to date [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] . It is the goal of this paper not only to demonstrate a case of a PLB that was not differentiated on imaging and was removed surgically but also to provide a radiologic algorithm for better noninvasive characterization of such masses in the future.…”