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Symptomatic giant peritoneal loose body in the pelvic cavity: A case report
Andreas Elsner1, Mikolaj Walensi2, Maya Fuenfschilling3
1Department of Surgery, Hospital of Baselland-Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland.
Introduction:
Giant peritoneal loose bodies (gPLB) occur rarely and therefore only few have been described. Often they are found incidentally and have no clinical relevance, whereas symptomatic forms may require surgical removal.
Presentation Of Case:
We report the case of a male patient suffering from abdominal discomfort with alternating localizations for several years, actually presenting with a proctitis. With elevated inflammatory markers, a conspicuous resistance in the lower abdomen and in order to evaluate further affection of the colon, an abdominal CT-scan was performed. It revealed a spherical mass in the lesser pelvis. A colonoscopy confirmed the proctitis, showing no further pathologies. Due to the symptoms and the uncertain entity of the mass, a diagnostic laparoscopy was performed and a boiled egg-like structure (diameter 5.2cm) was removed. The patient recovered well and was free of symptoms.
Discussion:
The patient had two potential reasons for his symptoms, one of them being a suspected leftover foreign body years after an appendectomy. The proctitis was treated conservatively but without complete remission of the abdominal discomfort. Therefore, a diagnostic laparoscopy was performed and the mass turned out to be a gPLB.
Conclusion:
To obtain a fast diagnosis and to perform an adequate conservative or surgical therapy, the knowledge about the rare entity of a gPLB is necessary. An exact anamnesis, clinical examination and the knowledge about the diagnostic values of radiological and endoscopic investigations are crucial.
Insights
Giant peritoneal loose bodies (gPLB) are rare, but this case highlights their potential to cause symptoms. Surgical removal of a gPLB resolved a patient's chronic abdominal discomfort and proctitis.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Radiology
Background:
- Giant peritoneal loose bodies (gPLB) are rare entities, with limited documented cases.
- While often incidental, symptomatic gPLB may necessitate surgical intervention.
Purpose of the Study:
- To report a case of a symptomatic gPLB presenting as chronic abdominal discomfort and proctitis.
- To emphasize the diagnostic challenges and management of this rare condition.
Main Methods:
- A male patient with chronic, migratory abdominal discomfort and proctitis underwent CT scan, revealing a pelvic mass.
- Colonoscopy confirmed proctitis without other pathologies. Diagnostic laparoscopy was performed for mass evaluation.
- A 5.2cm boiled egg-like structure, identified as a gPLB, was surgically removed.
Main Results:
- The patient experienced complete symptom resolution following the surgical removal of the gPLB.
- The gPLB was suspected to be a retained foreign body from a prior appendectomy.
Conclusions:
- Accurate diagnosis of gPLB requires thorough patient history, clinical examination, and judicious use of radiological and endoscopic tools.
- Awareness of gPLB is crucial for timely and appropriate conservative or surgical management.
- This case underscores the importance of considering rare diagnoses in persistent abdominal symptoms.
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