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| CASE REPORT |
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| Year : 2021 | Volume
: 27
| Issue : 2 | Page : 190-192 |
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Giant gastrocolic omental lipoma
G Adhip, MP Sreejayan
Department of General Surgery, Government Medical College, Kozhikode, Kerala, India
| Date of Submission | 11-Oct-2021 |
| Date of Decision | 15-Oct-2021 |
| Date of Acceptance | 20-Oct-2021 |
| Date of Web Publication | 15-Nov-2021 |
Correspondence Address:
Dr. G Adhip
Department of General Surgery, Government Medical College, Kozhikode - 673 008, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ksj.ksj_51_21
A lipoma is a benign noninvasive encapsulated mesenchymal tumor that resembles normal fat. It is ubiquitous and the most common tumor to affect soft tissues. Although lipoma may arise from any tissue containing fat, omental lipoma is extremely rare. We report a case of a 38-year-old female with no known comorbidities presenting with early onset of satiety, abdominal distension and nausea for the past 6 months. Contrast-enhanced computed tomography showed a lipomatous lesion in the region of the greater omentum, which was treated by surgical resection.
Keywords: Abdominal mass, laparotomy, omental lipoma
How to cite this article:
Adhip G, Sreejayan M P. Giant gastrocolic omental lipoma. Kerala Surg J 2021;27:190-2 |
| Introduction | |  |
Although a lipoma is a commonly occurring benign tumor, an omental lipoma represents a rare clinical entity, with the literature confined to case reports.[1] About 20 cases are reported from India. Among them, 15 cases were from pediatric population. Rest of them were from elderly patients. This may be the first time, a giant omental lipoma is reported in a young female. We present a case of a giant gastrocolic omental lipoma in a 30-year-old female, which was treated successfully by surgical resection.
| Case Report | | |
A 38-year-old female with no known comorbidities presented with early onset of satiety, abdominal distension, and nausea for the past 6 months. Personal and family histories were unremarkable except that she had loss of weight. Physical examination revealed a vague mass of 12 cm × 7 cm, firm, mobile and non-tender in the epigastrium. Laboratory investigations were normal, including normal hematology, Renal Function Tests (RFT) and Carcino Embryonic Antigen (CEA) level. Contrast-enhanced computed tomography (CT) showed poorly circumscribed homogeneous fat density measuring 13 cm × 8 cm × 8.8 cm in the region of greater omentum with gastrocolic separation, superiorly displacing antrum and pylorus [Figure 1]. Because of the size of the lesion, surgery was suggested to the patient. | Figure 1: Noncontraast computed tomography scan showing homogeneous fat density 13 cm × 8 cm × 8.8 cm in the region of greater omentum
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The patient underwent laparotomy and resection of the intra-abdominal lipoma. Intraoperatively, a 15 cm × 12 cm lipomatous lesion was seen arising from the gastrocolic ligament, with no invasion into the surrounding structures [Figure 2]. The lesion was resected [Figure 3] and [Figure 4] and the patient had an uncomplicated postoperative recovery. Histology of the specimen was consistent with lipoma [Figure 5]. | Figure 3: Postresection images of omental lipoma with gastro colic separation
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| Discussion | | |
Primary tumors of the greater omentum are rare.[1] The various primary tumors of the omentum reflect their predominant fatty connective tissue and vascular components such as leiomyosarcoma, fibrosarcoma, hemangiopericytoma, liposarcoma, leiomyoma, lipoma, fibroma, and mesothelioma.
A lipoma is a benign noninvasive encapsulated mesenchymal tumor that resembles normal fat. It is ubiquitous and the commonest tumor to affect soft tissues. Although lipoma may arise from any tissue containing fat, omental lipoma is extremely rare and commonly found in pediatric population.[2],[3]
Depending on the size, most of the omental lipomas remain asymptomatic, present with abdominal fullness, distension, or pain.[4] Large omental lipoma may undergo torsion and present as acute abdomen.[5],[6] Radiological investigations including ultrasonography and particularly CT are essential for characterizing the fatty nature of the mass, intra-abdominal localization, and detection of infiltration into surrounding organs. CT provides a definitive characterization of fat content and helps in localizing the lesion within the omentum.[7]
Magnetic resonance imaging too due to its excellent tissue characterization can also help detect complications like torsion of the tumor around its vascular pedicle.
The definitive management for omental lipoma is surgery.[8] Resection is not technically demanding, irrespective of size, owing to its encapsulated nature with a lack of infiltration into surrounding organs.[9] The rate of recurrence after excision is <5%.
| Conclusions | | |
Although a very rare diagnosis, omental lipomas should be considered in the differential diagnosis of intra-abdominal mass.
Patient consent
Obtained.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ishida H, Ishida J. Primary tumours of the greater omentum. Eur Radiol 1998;8:1598-601.  |
| 2. | Barauskas V, Malcius D, Jazdauskiene V. Lipoma of the greater omentum in a child. Medicina (Kaunas) 2004;40:860-3. |
| 3. | Hamidi H, Rasouly N, Khpalwak H, Malikzai MO, Faizi AR, Hoshang MM, et al. Childhood giant omental and mesenteric lipoma. Radiol Case Rep 2016;11:41-4. |
| 4. | Tan WJ, Chan WH. Giant omental lipoma. Singapore Med J 2012;53:e131-2. |
| 5. | Kinjo Y, Adachi Y, Seki K, Tsubono M. Laparoscopic resection for torsion of an omental lipoma presenting as an acute abdomen in a 5-year-old girl. J Surg Case Rep 2014;2014:rju072. |
| 6. | Beattie GC, Irwin ST. Torsion of an omental lipoma presenting as an emergency. Int J Clin Pract Suppl 2005;147:130-1. |
| 7. | 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. |
| 8. | Abubakar AM, Mayun AA, Pindiga UH, Chinda JY, Adamu SA. Giant omental lipoma in a 13-year-old adolescent girl. J Pediatr Surg 2009;44:2230-2. |
| 9. | Chaudhary V, Narula MK, Anand R, Gupta I, Kaur G, Kalra K. Giant omental lipoma in a child. Iran J Radiol 2011;8:167-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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