Sewkani et al. Journal of Medical Case Reports 2011, 5:297 http://www.jmedicalcasereports.com/content/5/1/297 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access ’Boiled egg’ in the peritoneal cavity-a giant peritoneal loose body in a 64-year-old man: a case report Ajit Sewkani1*, Aruna Jain2, KK Maudar1 and Subodh Varshney1 Abstract Introduction: Peritoneal loose bodies, or peritoneal mice, are rare asymptomatic lesions that are usually found as an incidental finding during abdominal surgery or autopsy. Giant loose bodies, measuring more than 5 cm, are rare and only a few cases are reported in the literature. These bodies are usually infarcted appendices epiploicae, which become detached and appear as a peritoneal loose body in the abdominal cavity. They may re-attach themselves to a surface, such as the lower aspect of the spleen or omentum, in which case they can be called a “parasitized peritoneal body”, as in our case. Case Presentation: We report a case of a giant loose peritoneal body measuring 7 × 5 cm found incidentally in a 64-year-old Indian man who presented with acute intestinal obstruction. We present the current hypothesis and our opinion on the genesis of such large bodies and discuss the problems in diagnosis. Conclusion: Peritoneal loose bodies are common but giant peritoneal loose bodies are very rare. These giant bodies usually do not require any treatment until they become complicated. Present diagnosis modalities have limitations in the diagnosis of mobile lesions in the abdominal cavity, so care must be taken to avoid unnecessary laparotomies in uncomplicated cases. Introduction Peritoneal loose bodies are rare and found incidentally at laparotomy. In most cases they are small in size (usually less than 1 cm). Giant loose bodies (more than 5 cm) are very rare and only a few cases have been reported in the literature [1-10]. Its exact pathogenesis is not known but the most common origin of these bodies are appendices epiploicae (by the sequential process of torsion, infarc- tion, saponification and calcification) [1,2]. These loose bodies are usually incidental findings that do not require any specific treatment until they become complicated [3-6]. Generally, computed tomography (CT) and magnetic resonance imaging (MRI) are useful for diagnosis of these lesions; however present literature shows the limitation in the diagnosis of movable masses by CT and MRI [2,7]. We report a case of a giant loose peritoneal body with special reference to the genesis of * Correspondence: drasingh73@gmail.com 1Department of Surgical Gastroenterology & Clinical Nutrition, Bhopal Memorial Hospital and Research Center, Bhopal (MP) 462038, India Full list of author information is available at the end of the article such large bodies and also discuss the problems in diagnosis. Case Report A 64-year-old Indian man was referred with complaints of abdominal pain, vomiting and not passing flatus or feces for four days. Our patient’s general condition was poor; he was febrile, with a pulse rate of 124/minute and blood pressure 90 mm/Hg. X-rays of his abdomen showed mul- tiple air fluid levels suggestive of acute intestinal obstruc- tion. With the provisional diagnosis of acute abdomen (acute intestinal obstruction) our patient was resuscitated and sent for an urgent laparotomy. On exploration, our patient had severely dilated small gut loops with the term- inal ileal loop twisted around the omental band and adher- ent to his left pelvic wall. On releasing the omental band, the ileal loop was dissected free from his left pelvic wall. Once the loops had been released, we found a large, white, oval shaped, extra-luminal body in the region of his sig- moid colon (Figure 1). The body was soft to firm in con- sistency (resembling a boiled hen’s egg) and attached © 2011 Sewkani et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.