- Visibility 676 Views
- Downloads 664 Downloads
- Permissions
- DOI 10.18231/j.ijpo.2025.040
-
CrossMark
The mystery of free-floating peritoneal loose body: An incidental intraoperative finding in a case of hernioplasty
- Author Details:
-
Azhagunila Adinarayanane
-
Umasankary Calaisselvane
-
Banushree CS *
-
Mima Maychet B Sangma
Banushree CS *
Background: Peritoneal loose body (PLBs) is an unusual presentation occurring as a free-floating mass in the peritoneal cavity. They remain asymptomatic for longer periods but may produce vague abdominal pain on occasion. They are generally an incidental finding during imaging studies, surgery or autopsies. It can occur due to torsion, infarction and saponification of large appendices epiploicae leading to its auto-amputation that freely floats in the peritoneal cavity.
Case Report: We report a case of a 53-year-old lady who presented with complaints of lower abdominal pain on and off for the past 3 months with a prior history of surgeries. On examination, she had mild tenderness in the left lumbar and lower abdomen with no guarding or rigidity. Ultrasound of the abdomen and pelvis revealed a posterior rectus sheath hernia. She was planned for hernial repair. Intraoperatively, when the peritoneal cavity was explored, a small greyish-white nodule was found floating within the cavity and was free of attachments. Gross examination revealed a firm to hard, greyish yellow, ovoid, glistening nodular mass that was gritty on slicing with the cut surface showing central necrosis and calcification. Histopathological examination revealed a well-circumscribed nodule with dense collagenous tissue at the periphery with central necrotic debris and cholesterol clefts undergoing calcification.
Conclusion: PLBs are rare, benign asymptomatic intraperitoneal lesions found incidentally. Preoperative diagnosis of PLBs is difficult and can mimic features of a malignant tumour making its diagnosis challengeable for the surgeons. Hence, it is necessary to differentiate PLBs from neoplastic or metastatic lesions by Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in different positions and by pathological examination.
Keywords: Peritoneal loose body, Appendices epiploicae, Hernioplasty, Calcifying fibrous Pseudotumour, Peritoneal mice.
References
- Ariaya A, Ahmed M, Mindaye ET. Incidental peritoneal loose body in a polytrauma patient: The unnoticed scenario: A case report. Int J Surg Case Rep. 2021;85:106158.
- Guo S, Yuan H, Xu Y, Chen P, Zong L. Giant peritoneal loose body: A case report. Biomed Rep. 2019;10(6):351–3.
- Huang Q, Cao A, Ma J, Wang Z, Dong J. Two giant peritoneal loose bodies were simultaneously found in one patient: A case report and review of the literature. Int J Surg Case Rep. 2017;36:74–7.
- Kim HS, Sung JY, Park WS, Kim YW. A giant peritoneal loose body. Korean J Pathol. 2013;47(4):378–82.
- Sewkani A, Jain A, Maudar K, Varshney S. 'Boiled egg' in the peritoneal cavity-a giant peritoneal loose body in a 64-year-old man: a case report. J Med Case Rep. 2011;5:297.
- Dhoot NM, Afzalpurkar S, Goenka U, Mahendra V, Khan EM, Sutradhar A, et al. A rare peritoneal egg: Case report with literature review. Radiol Case Rep. 2020;15(10):1895–900.
- Mehammed AH, Bezabih NA, Gebresilassie MY, Hailu YA, Semahegn MY, Damtie MY. Unveiling the rarity: A case report of giant peritoneal loose body. Radiol Case Rep. 2024;19(11):5492–
- Sang W, Li Y, Hong X, Qu H, Zhu R, Yi Q. Giant peritoneal loose body and its protein composition: a case report. BMC Urol. 2024;24(1):43.
- Matsubara K, Takakura Y, Urushihara T, Nishisaka T, Itamoto T. Laparoscopic extraction of a giant peritoneal loose body: Case report and review of literature. Int J Surg Case Rep. 2017;39:188-
- Obaid M, Gehani S. Deciding to remove or leave a peritoneal loose body: A case report and review of literature. Am J Case Rep. 2018;19:854-7.
- Patel DN, Patel RR, Desai HK, Patel RK. A rare case of peritoneal loose body (mice) in left sided inguinal hernial sac. Annal Urol Nephrol. 2020;2(4).
- Jang JT, Kang HJ, Yoon JY, Yoon SG. Giant Peritoneal Loose Body in the Pelvic Cavity. J Korean Soc Coloproctol. 2012;28(2):108–10.
- Harrigan AH. Torsion and inflammation of the appendices epiploicae. Ann Surg. 1917;66(4):467–78.
- Asabe K, Maekawa T, Yamashita Y, Shirakusa T. Endoscopic extraction of a peritoneal loose body: a case report of an infant. Pediatr Surg Int. 2005;21(5):388–9.
- Mohri T, Kato T, Suzuki H. A giant peritoneal loose body: report of a case. Am Surg. 2007;73(9):895–6.
- Hedawoo JB, Wagh A. Giant peritoneal loose body in a patient with haemorrhoids. Trop Gastroenterol. 2010;31(2):132–3.
- Ansari N, Suryavanshi P, Singh GN, Roy S, Verma S. Rolling egg- shaped peritoneal loose body (plb): a diagnostic dilemma for surgeons and radiologists. Cureus. 2022;14(11):e31214.
- Ghahremani GG, White EM, Hoff FL, Gore RM, Miller JW, Christ ML. Appendices epiploicae of the colon: radiologic and pathologic features. Radiographics. 1992;12(1):59–77.