The patient had an uneventful recovery and was discharged from the hospital on the fifth postoperative day. She remains asymptomatic at the 12-month follow-up, with no evidence of recurrence on follow-up USG.
Intraperitoneal lipomas are rare in childhood. Only seven cases have been reported so far arising from the greater omentum 1–7. When cases of lipoblastomas are added, the tally comes to about nine cases 7–9. These presented from the age of 9 months to 13 years 1–9 (Table 1). No sex predilection has been noted so far. There is gradual abdominal distension or a palpable lump 1,4–9. Early satiety, vomiting, and abdominal pain owing to pressure effects on surrounding structures or an emergent presentation because of torsion or partial intestinal obstruction have been reported 2,3,9,12.
The differential diagnosis includes teratoma, lymphangioma, lymphoma, alimentary tract duplications, and neuroblastoma. Lipomas are homogeneous, highly echogenic, and encapsulated on USG. A lymphoma is usually hypoechoic and a neuroblastoma is often highly echogenic. Another close differential is lipoblastoma, which appears as a well-defined hypoechoic myxoid mass embedded within highly echogenic fat 13. Identification of fat with CT is on the basis of an attenuation of less than ∼20 HU. Other lesions with predominant macroscopic fat include teratoma, myelolipoma, angiomyolipoma, liposarcoma, lipoma, epiploic appendagitis, and omental infarction 11.
The histology in lipoma will show lobules of mature adipocytes, whereas in lipoblastoma, the cells will range from immature lipoblasts to mature adipocytes and the cells may be separated by fibrous septa 10. The absence of calcification on CT, normal α fetoprotein, and presence of a normal kidney and adrenals negated the diagnosis of teratoma, hepatoblastoma, nephroblastoma, and a cystic neuroblastoma 1–9.
There are no conflicts of interest.
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