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Year : 2009  |  Volume : 6  |  Issue : 1  |  Page : 68-69
Giant omental and mesenteric lipoma in an infant


K.G.S. Scan Centre, 766, Anna Nagar, Madurai-625 020, India

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How to cite this article:
Srinivasan K G, Gaikwad A, Ritesh K, Ushanandini K P. Giant omental and mesenteric lipoma in an infant. Afr J Paediatr Surg 2009;6:68-9

How to cite this URL:
Srinivasan K G, Gaikwad A, Ritesh K, Ushanandini K P. Giant omental and mesenteric lipoma in an infant. Afr J Paediatr Surg [serial online] 2009 [cited 2019 Nov 12];6:68-9. Available from: http://www.afrjpaedsurg.org/text.asp?2009/6/1/68/48585
Sir,

Primary tumours of the greater omentum are very rare. Fatty tumours like lipoma are very well depicted on computed tomography (CT) and magnetic resonance imaging (MRI). We present a case of large omental and mesenteric lipoma in an infant which occupied nearly whole of the abdomen. After surgry, a large lipoma weighing about 1.5 kg was obtained. The huge size of the lipoma, occupying the entire abdominal cavity from diaphragm to the pelvis makes it a rare case. The CT findings are discussed in detail.

A 9-month-old child presented with abdominal distension and intermittent diarrhoea of 3 months duration. On clinical examination, a large soft to firm mass was felt extending from the epigastrium to the pelvis. Ultrasound (US) examination of the abdomen (G-50, Siemens, Germany) showed a huge heterogeneously hyperechoic mass lesion occupying the whole abdomen. The lesion was seen to displace the bowel loops towards the periphery. No obvious calcification was seen. Further evaluation was done with contrast enhanced CT scan of the abdomen and pelvis (Espirit, Siemens, Germany). The CT scan revealed a huge fat density (-50 to -100 H) lesion occupying whole of the abdomen extending from just beneath the diaphragm [Figure 1] to the pelvis. The retroperitoneal structures were displaced posteriorly and the bowel loops towards the periphery. Thin fibrous septations were also noted within the lesion. Vessels were noted traversing the lesion. The lesion was compressing and traversing through the spaces between bowel loops rather than infiltrating them [Figure 2]. A diagnosis of mesenteric lipoma was made. Laparotomy was performed which revealed a large yellowish tumour occupying the whole abdomen. The tumour was inseparable from both the omentum and the mesentry. Transverse colon loop was partly engulfed by the tumour and by careful dissection the tumour was removed in toto which weighed 1.5 kg [Figure 3]. Histopathological examination confirmed the diagnosis of lipoma.

Lipoma of the abdominal cavity, a benign neoplasm of mature fat cells usually presents as an asymptomatic abdominal mass or progressive abdominal distension. Lipomas are sometimes detected incidentally as an intraperitoneal radiolucent fat density mass on CT scan. [1]

Lesions with predominantly microscopic fat include adrenal adenoma and some teratomas. Macroscopic fat can be identified with both CT and MRI. Identification of fat with CT is based on the attenuation (less than -20 HU). Several MRI techniques are used for fat suppression like spectroscopic fat saturation and chemical shift (in-phase/opposed-phase) imaging. Lesions with predominantly macroscopic fat include teratoma, myelolipoma, angiomyolipoma, liposarcoma, lipoma, epiploic appendagitis and omental infarction. [2]

In case of omental tumours, CT determines the omental origin of the tumour and also depicts the precise anatomical features, which is very difficult by US. Thus, when US shows an abdominal tumour of unknown origin, CT should be performed for further evaluation keeping the possibility of an omental mass in mind. [3]

 
   References Top

1.Luo X, Gao W, Zhan J. Giant omental lipoma in children. J Pediatr Surg 2005;40:734-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Pereira JM, Sirlin CB, Pinto PS, Casola G. CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: Techniques, diagnosis, differential diagnosis, and pitfalls. Radiographics 2005;25:69-85.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Ishida H, Ishida J. Primary tumours of the greater omentum. Eur Radiol 1998;8:1598-601.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]

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Correspondence Address:
K G Srinivasan
K.G.S. Scan Centre, 766,Anna Nagar, Madurai-625 020
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.48585

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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