A giant lipoma of the parietal peritoneum: Laparoscopic excision with the parietal peritoneum preserving procedure – a case report with literature review
Lipomas are very common benign tumors of mature fatty tissue that can occur in any part of the body. However, lipomas of the parietal peritoneum are extremely rare.
Case presentation
A 36-year-old man presented with urinary frequency for 6 months. On computerized tomography of the abdomen and pelvis, a well-defined fatty mass measuring 20 × 11 × 6.5 cm in size, was found in the lower abdominal cavity. We performed a laparoscopic parietal-peritoneum-preserving excision of the mass. The patient was discharged without complications on post-operative day 6.
Conclusions
To our knowledge, a laparoscopic excision with preservation of the parietal peritoneum for a giant parietal peritoneal lipoma has never been reported. Herein, we report a case of a giant lipoma of the parietal peritoneum successfully managed by laparoscopy.
Hinweise
This work was supported by the intramural research grant of Chungbuk National University in 2015.
Abkürzungen
A-P CT
Abdominal and pelvic computed tomography
Background
Lipomas are very common benign tumors of mature fatty tissue that can occur in any part of the body. There are a few reports of giant lipoma of mesentery or omentum [1‐4]. However, lipomas of the parietal peritoneum are extremely rare. And there have been no reports of extremely large-sized lipomas of the parietal peritoneum. We describe a case of a giant lipoma of the parietal peritoneum causing urinary frequency secondary to external compression of the bladder. This tumor was successfully managed by laparoscopic excision with preservation of the parietal peritoneum.
Case presentation
A 36-year-old man presented with urinary frequency for 6 months. He had no significant urologic abnormality and no palpable abdominal mass on physical examination. He denied abdominal pain, vomiting, anorexia, or bowel disturbances. There were no specific laboratory abnormalities. The abdomen and pelvis computed tomography scans showed a 20 × 11 cm, well-defined, fatty mass in the abdominal cavity. A mass was located between the abdominal wall muscles and the peritoneum and compressed bladder (Fig.1a, b). We performed surgery, firstly. The reasons are as follows: (1) the mass was just beneath the abdominal wall, (2) the patient had symptom (urinary frequency), and (3) the mass was considered benign from well-demarcate mass with homogenous features on CT scan. We performed a laparoscopic mass excision with preservation of the parietal peritoneum. Two 11-mm ports were inserted, one supra-umbilically, and the other in the left lower abdomen. A 5-mm port was inserted in the right lower abdomen. A huge, freely mobile, soft mass in the external peritoneal layer with no connection to other organs was seen in the lower abdomen (Fig.2a). After demarcating the mass, we excised the parietal peritoneum through the marked line with a monopolar instrument. Next, we dissected the mass from the peritoneum (Fig. 2b). The mass which was excised completely, was placed in a large plastic endopouch-type bag, and extracted through the extended left port site. Finally, the preserved peritoneum was fixed to the abdominal wall using a fixing material with a closed suction drain (Fig. 2c, d). The operative time was 90 min, with no estimated blood loss. The resected specimen size was 22 × 16 × 7.5 cm3, and the weight was 942 g. The pathological diagnosis was reported benign lipoma with clear resection margin. The patient was discharged without complications on post-operative day 6.
×
×
Anzeige
Discussion and conclusions
In 2006, the first case of a lipoma of the parietal peritoneum was reported by Barut et al [5]. Since then, only 5 more cases have been reported (Table 1). In previous reports, all the patients presented with abdominal pain. Three cases were presented with right quadrant abdominal pain mimicking appendicitis, and the largest lipoma had a diameter of 6.3 cm [6‐10]. Our patient presented with urinary frequency caused by external compression of the bladder. A huge and heavy lipoma measuring 22 × 16 × 7.5 cm3 and 942 g disturbed the filling capacity of the bladder. In 4 previously reported cases, because the lipomas were small in size, they performed a laparoscopic excision of the lipoma and its associated peritoneum [6, 8‐10]. In our case, we performed a peritoneal-preserving excision of the lipoma to reduce the pain that we anticipated might be caused by peritoneal resection. Since our patient’s lipoma was large in size, we dissected between the peritoneum and the lipoma, and the peritoneum was preserved with fixation around the abdominal wall. The fixation device (Protack™, Medtronic) which is often used in laparoscopic hernioplasties, was useful for fixation. To our knowledge, a laparoscopic excision with preservation of the parietal peritoneum for a giant parietal peritoneal lipoma has never been reported. This procedure is feasible for decreasing postoperative pain and better cosmetic results.
Table 1
Reports regarding the treatment of a lipoma of the parietal peritoneum in the literature
Reference (year)
Age (years)
Sex
Presentation
Surgical procedure
Maximum diameter (cm)
Barut et al. [4] (2006)
67
Female
Abd pain, nausea vomiting
Open
6
Bunker et al. [5] (2013)
34
Female
Abd pain
Laparoscopy
–
Bang et al. [6] (2014)
75
Male
Abd pain, palpable mass
Open
4.5
Shrestha et al. [7] (2014)
32
Male
Abd pain, loss of appetite
Laparoscopy
3
Sathyakrishna et al. [8] (2014)
21
Female
Abd pain
Laparoscopy
–
Salgaonkar et al. [9] (2016)
79
Male
Abd pain
Laparoscopy
6.3
Present case (2018)
36
Male
Urinary frequency
Laparoscopy
22
In conclusion, this case highlights the fact that a giant lipoma of the parietal peritoneum can be an unusual cause of urinary disturbances. Laparoscopic procedures are feasible for the excision of a huge lipomas of the parietal peritoneum, and concomitant preservation of the peritoneum is useful for reducing postoperative pain.
Availability of data and materials
All data generated or analyzed during this study are included in this published article and its supplementary information files.
Ethics approval and consent to participate
Not applicable.
Anzeige
Consent for publication
Written informed consent was obtained from the participant for publication of this article and any accompanying tables/images. A copy of the written consent is available for review by the Editor of this journal.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
A giant lipoma of the parietal peritoneum: Laparoscopic excision with the parietal peritoneum preserving procedure – a case report with literature review
verfasst von
Hanlim Choi DongHee Ryu Jae-Woon Choi Yanjie Xu Yook Kim
Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.
Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.