Intermuscular lipoma in a 4-year-old child presenting like Spigelian hernia

Abstract

Lipomas are commonest benign tumor and can occur at any part of the body, but intermuscular lipomas are very rare and usually occur at middle age or later. Intermuscular lipomas remain hidden till they attain a large size. They commonly appear on anterior abdominal wall. We treated a case of intermuscular lipoma in a 4-year-old girl. It presented as a bulge at right iliac fossa during straining; its location and symptoms were similar to that of Spigelian hernia. Actual diagnosis was made under general anesthesia and complete surgical excision was done. This is a rare mode of presentation of an intermuscular lipoma. Intermuscular lipoma of the abdominal wall at this young age was not reported earlier.

Large Intermuscular Lipoma Presenting as a Groin Hernia

“…Although subcutaneous lipomas are common, intermuscular lipomas consist of only 1.8% of all soft tissue tumours. When located over the anterior abdominal wall, the lump may not be obvious until the lipoma attains a large size [ 2 ]. The larger sized lesions can herniate through the abdominal wall or groin, however, the herniating part may only represent the “tip of the iceberg” and the remainder still undetected [ 6 ].…”

“…It is thus possible that the lipoma originated from preperitoneal fat (cord lipoma) and grew into the intermuscular space as suggested by the presence of the lipoma on both sides of the rectus sheath (intra-rectus space and preperitoneal space). Asymptomatic large anterior abdominal wall intermuscular lipomas may not be detected as an obvious lump, but rather as some fullness noted on straining or coughing [ 2 ]. This may be associated with a hernia, muscle aches, or shooting pains if the lipoma compresses a nerve [ 2 ].…”

“…They can either be found between the muscles (intermuscular) or within the muscles (intramuscular). Both of these are rare with an incidence of 0.3% and 1.8% respectively of fatty tumors, seen predominantly in the middle-aged and older population [1][2][3].…”

Giant gluteal lipoma in childhood: a case report

“…Imaging methods can be used for the diagnosis of lipomas. The most commonly used and first preferred method is ultrasonography [8]. Computerized tomography (CT), magnetic resonance imaging (MRI) or thin needle aspiration can be used for the diagnos that cannot defined by ultrasonography [5][6][7].…”

Lipoencephalocele in a Child: An Uncommon Swelling in the Occipital Region

“…Lipomas are one of the most commonly encountered benign mesenchymal tumors of mature adipose tissue and are commonly found in the subcutaneous plane in the extremities and trunk [1] . Neural tube defects are common congenital malformations of the central nervous system.…”