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- Title
A Case of a Fixed Giant Peritoneal Loose Body outside the Peritoneum and near the Rectovesical Excavation.
- Authors
Kotaro Nanno; Seiichi Shinji; Takeshi Yamada; Akihisa Matsuda; Ryo Ohta; Hiromichi Sonoda; Takuma Iwai; Kohki Takeda; Kazuhide Yonaga; Koji Ueda; Sho Kuriyama; Toshimitsu Miyasaka; Hiromasa Komori; Yoshinobu Shioda; Hiroshi Yoshida
- Abstract
Departments of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan A peritoneal loose body (PLB) is tissue completely separated from other intraperitoneal organs. It is rare and usually found incidentally during laparotomy, examination, or autopsy. PLBs are usually located free in the peritoneal cavity and not in the extraperitoneal space. They are thought to originate when epiploic appendices are released into the abdominal cavity after ischemic necrosis. We report a case of a giant PLB outside the peritoneal cavity, adjacent to the rectovesical excavation, that was identified preoperatively in an asymptomatic 83-year-old man undergoing evaluation for cholecystolithiasis. Computed tomography revealed a mass with well-defined margins in the rectovesical excavation. The mass (diameter, 60 mm) consisted of a calcified core and peripheral soft tissue and did not appear to invade adjacent organs. Although there were no symptoms or tumor growth over time, we scheduled a laparoscopic extraction for definitive diagnosis. On laparoscopic exploration, a white ovoid mass was found in the rectovesical excavation; there was no invasion of adjacent organs. We diagnosed a giant PLB. Postoperative recovery was uneventful. Most PLBs are asymptomatic and do not require surgery, except when symptoms are present, when the PLB is large, or when malignancy is suspected. PLB is rarely extraperitoneal and is usually freely mobile; however, in our patient, it was fixed and outside the abdominal cavity, near the rectovesical fossa. Although it could not be diagnosed preoperatively as being extraperitoneal, imaging findings were typical of PLB; thus, it was possible to remove the mass laparoscopically without bowel resection.
- Subjects
ABDOMEN; PERITONEUM; GASTROINTESTINAL surgery; ASYMPTOMATIC patients; COMPUTED tomography
- Publication
Journal of Nippon Medical School, 2023, Vol 90, Issue 3, p276
- ISSN
1345-4676
- Publication type
Article
- DOI
10.1272/jnms.JNMS.2023_90-302