[Idiopathic segmental fatty tissue necrosis of the ligamentum teres hepatis. Variation on a theme...]

Idiopathic segmental infarction of the peritonealized intra-abdominal fatty tissue is a rare cause of acute abdominal distress. Patients are operated for by suspected acute appendicitis or cholecystitis, and the true diagnosis is made intraoperatively.

A 32-year-old woman was admitted to our hospital with a 2-day history of pain in the right upper abdomen. Clinical presentation suggested acute cholecystitis, but laboratory evaluation and sonography revealed no pathological findings. Because of a distinctly palpable and very painful epigastric tumor 2 x 3 x 3 cm, a CT scan was performed, that showed a clearly circumscribed mass in the ligamentum teres hepatis with hyperattenuating, infiltrating streaks. Laparoscopy was performed, and a tumor was found, that was adherent to the stomach's antrum and could easily be resected. Twenty-four hours after surgery the patient only felt slight discomfort and could be dismissed on the second day. Pathology report revealed a hemorrhagic infarction of the fatty tissue, which can be histologically found in idiopathic segmental necrosis of the greater omenum or the appendices epiploicae.

Laparoscopy is an excellent diagnostic tool and also has therapeutic possibilities. Resection of the necrotic tissue ensures faster recovery and pain control and should be performed to prevent complications such as bacterial superinfection with formation of an abscess or spontaneous bleeding.