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.