Rolling Egg-Shaped Peritoneal Loose Body (PLB): A Diagnostic Dilemma for Surgeons and Radiologists

A man in his mid-50s presented with heaviness in the right lower abdomen for the last three months. Ultrasonography (USG) showed an intra-abdominal mass in the right iliac fossa. Contrast-enhanced CT (CECT) revealed a well-defined circumscribed mass near the ileocaecal junction, with a hypodense center, surrounded by a hyperdense periphery and well-defined capsule. A lower midline laparotomy was performed. Intraoperatively, a white, firm, smooth ball-like mass was found, lying freely in the abdomen. Histopathology revealed fatty tissues surrounded by a calcified shell, which was further surrounded by proteinaceous material. Such peritoneal loose bodies (PLBs) are free masses in the abdomen, with variable sizes. These are asymptomatic, unless they compress any nearby viscera, as was in our case. The objective of this case report is to make surgeons and radiologists aware of this rare entity, which can be a source of confusion in a case of mass in the abdomen.