Sewkani et al. Journal of Medical Case Reports 2011, 5:297 http://www.jmedicalcasereports.com/content/5/1/297 Pre-operative diagnosis of these lesions is difficult, because most of the time these lesions are asymptomatic and found during routine exploration of the abdomen for some other pathology. The most common form of presentation in sympto- matic patients is causing intestinal obstruction, as in this case. If a patient presents with features of intestinal obstruction and X-ray films shows a calcified lesion in the abdomen, which moves with a change in position of the patient, there should be a high index of suspicion for diagnosis of a giant loose peritoneal body. Additional tests which can be done to diagnose peritoneal mice are CT and MRI scans, which can be useful for differentiat- ing these from other lesions. However, it is very difficult to differentiate between these loose bodies and other abdominal benign lesions with calcification, like granu- loma or tuberculosis. In our case, because the patient presented with acute intestinal obstruction and an X-ray of his abdomen only showed multiple air-fluid levels and no calcified lesions, our patient was directly taken up for an urgent laparot- omy without waiting for CT or MRI scans. Conclusion Peritoneal loose bodies are rare and, in most of the cases, small in size. However, giant loose bodies are very rare and only a few cases have been reported in the lit- erature. The current hypothesis on their development is uncertain. Pre-operative diagnosis of these lesions is difficult and a high index of suspicion should be kept in any sympto- matic patient with a mobile lesion in the abdomen or a calcified lesion in the pelvis on X-ray. No specific treatment is required in asymptomatic patients, however if these entities become associated with complications like intestinal obstruction, or if there is an abdominal mass of obscure origin, or when diag- nosis is in doubt, then exploration is required. Consent Written informed consent for publication could not be obtained despite all reasonable attempts. Every effort has been made to protect the identity of our patient and there is no reason to believe that our patient would object to publication. Author details 1Department of Surgical Gastroenterology & Clinical Nutrition, Bhopal Memorial Hospital and Research Center, Bhopal (MP) 462038, India. 2Department of Pathology, Bhopal Memorial Hospital and Research Center, Bhopal (MP) 462038, India. Authors’ contributions AS assisted in the operation, contributed to manuscript conception, research, acquisition of data, drafting and writing of the manuscript as well Page 3 of 3 as pre-operative and post-operative management of the patient. AJ carried out the histopathological evaluation and critically review of the manuscript. KKM carried out the critical review and revision of the manuscript. SV carried out the operation and contributed to the critical review of the manuscript. 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