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

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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.