Case report

A 22-year-old Tunisian man without a medical history presented to the hospital with abdominal pain located in the right iliac fossa. The pain began 2 years ago with a paroxysmal evolution, but it has worsened over the last 6 months. The patient also complained of chronic abdominal discomfort. There was no signs of bowel obstruction. Physical examination found tenderness of the right iliac fossa without a palpable mass (Figure 1). Biology tests showed no abnormalities, in particular, C-reactive protein was within the normal range. We performed an abdominal ultrasound which showed a well-defined, homogenous mass of the right iliac fossa of 10 x 8 cm.
The abdominal scan showed a well-defined mass in the mesentery measuring 12 x 9 cm with fat density surrounded by a thin capsule. This mass did not enhance after injection of contrast product with no septum or calcification. There was no lymphadenopathy or invasion of neighboring organs. The CT scan images were most consistent with a mesenteric lipoma (Figure 2). Therefore, surgery was decided. Exploration of the abdomen by midline laparotomy revealed an encapsulated, mobile and yellowish mass originating from the ileal mesentery without any adhesions to other organs. There were no necrosis or hemorrhage within the mass. Complete excision of the lesion was performed with a clear plan of cleavage between the tumor and the ileal mesentery (Figure 3,4). The mesenteric bed was kept intact with its vascular structures (Figure 5). The pathology of the specimen was consistent with benign lipoma. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Upon follow up, the patient was followed up regularly for more than 2 years. No recurrence has been diagnosed.