Giant peritoneal loose body : an instance of incidentaloma or warranted concern?

Abstract

A 79-year-old male, diagnosed with essential hypertension, was referred with a long-standing history of abdominal pain, colicky and global in radiation, accompanied by anorexia and loss of weight of approximately 5 kg in two years. On further inquiry, he reported no lower urinary tract or obstructive symptoms. He had had no prior hospital admission or surgical intervention. He reported no family history of cancer and is a teetotaller.His general and systemic examination was unremarkable. In particular, he had no features of wasting or anaemia. His vital signs were normal. Abdominal examination revealed a fullness, with impression of mass, in the right lower quadrant, but no signs of peritonism. On digital rectal examination the prostate was smooth and firm with no other abnormality.His abdominal radiographs showed calcifications in the pelvis that were thought to be phleboliths. His baseline blood tests showed no anaemia, normal renal function and normal value tumour markers. An outpatient upper endoscopy and colonoscopy were normal. A CT abdomen was then requested, which showed a well-defined mass measuring 6.74 x 7.9 x 8.18 cm, with a central area of calcification with a differential diagnosis of a teratoma or non-benign lesion (Figure 1).Due to the uncertainty of diagnosis and suspicion of nonbenign lesion, the patient was counselled and consented SummaryIn non-specific abdominal pain, cross-sectional imaging, often valued more than clinical examination in today's technologically advanced age, may reveal a large incidentaloma, posing questions regarding its relation to symptoms and the need for surgical removal. This is a situation that highlights the potential for early detection and treatment yet raises the question as to whether surgery is indeed indicated. This report relates the case of a 79-year-old male, with a longstanding history of abdominal pain, who had a giant loose peritoneal body removed. We discuss the reasons for removal and its pathogenesis.