A Giant Pre-Peritoneal Lipoma: A Report of an Uncommon Presentation of a Rare Entity and a Review of the Literature

Abstract

Background: A lipoma is one of the commonest benign tumors in surgical practice. Lipomas are usually found on the trunk and limbs but less commonly within the abdomen, where they occur frequently in the mesentery as well as the subserosa and submucous layer of the gastrointestinal tract. Pre-peritoneal lipomas are rare. Case Presentation: A 44-year-old woman presented with a painless and progressive right-sided abdominal swelling of 5 months duration. Examination revealed a 16cm x 14cm slightly mobile and non-tender firm-to-hard hour-glass-shaped mass extending from the right hypochondrial to right iliac and the suprapubic regions. Abdominal ultrasonography showed a 5cm x 6cm bowel thickening in the right iliac fossa suggestive of an ileocecal mass while a computerized tomography showed a 20.8cm x 6.3cm x 20.1cm hypodense mass within the peritoneal cavity, extending from the epigastric region to the pelvis, anterior to the bowel loops and more to the right. At laparotomy, a huge, well encapsulated yellowish mass in the pre-peritoneal space, weighing 1,520g was excised. Histology confirmed a lipoma. Conclusion: A preperitoneal lipoma is an uncommon soft tissue tumor and the giant ones are extremely rare. Although a rare cause of a painless abdominal swelling, pre-peritoneal lipoma should be considered as a differential diagnosis in patients presenting with an unremarkable feature suggestive of an intra-abdominal pathology.