Giant retroperitoneal lipoma in a child misdiagnosed as Hirschsprung's disease

Aditya Pratap Singh; Dinesh Kumar Barolia; Ramesh Tanger; Arun Kumar Gupta

doi:10.4103/jmgims.jmgims_20_18

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CASE REPORT

Year : 2019 | Volume : 24 | Issue : 2 | Page : 99-100

Giant retroperitoneal lipoma in a child misdiagnosed as Hirschsprung's disease

Aditya Pratap Singh, Dinesh Kumar Barolia, Ramesh Tanger, Arun Kumar Gupta
Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Date of Web Publication

17-Sep-2019

Correspondence Address:
Dr. Aditya Pratap Singh
Near the Mali Hostel, Main Bali Road, Falna, Pali, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jmgims.jmgims_20_18

Abstract

Retroperitoneal lipomas have remained the essentially rare tumors seen in clinical practice. The tumors are rarer in children, with very few reported cases in surgical literature worldwide. We report the case of a 5-year-old child who presented with a giant retroperitoneal lipoma that was successfully managed by complete excision. There has been no recurrence noticed during follow-up. We present a rare case of giant retroperitoneal lipoma in a child. At laparotomy, a giant lipoma weighing about 6 kg was excised.

Keywords: Excision, Hirschsprung's disease, lipoma, retroperitoneal

How to cite this article:
Singh AP, Barolia DK, Tanger R, Gupta AK. Giant retroperitoneal lipoma in a child misdiagnosed as Hirschsprung's disease. J Mahatma Gandhi Inst Med Sci 2019;24:99-100

How to cite this URL:
Singh AP, Barolia DK, Tanger R, Gupta AK. Giant retroperitoneal lipoma in a child misdiagnosed as Hirschsprung's disease. J Mahatma Gandhi Inst Med Sci [serial online] 2019 [cited 2023 Mar 29];24:99-100. Available from: https://www.jmgims.co.in/text.asp?2019/24/2/99/267004

Introduction

Retroperitoneal lipoma is an unusual entity that is most often found in adults between 40 and 60 years of age and rarely occurs in the first decade of life. Retroperitoneal benign lipomas are extremely rare and represent about 2.9% of all primary retroperitoneal tumors and about 80% of them are malignant neoplasms.^[1]

Case Report

A 5-year-old male child presented to our department with a progressive abdominal distention. Otherwise, the child was asymptomatic. The child initially treated as a case of Hirschsprung's disease, but barium enema was normal. There was no history of vomiting, fever, delayed meconium, and constipation. All routine blood investigations were within normal limits including gamma transglutaminase and thyroid profile. A plain X-ray of the abdomen revealed a soft-tissue mass in the left side of abdomen displacing and compressing the bowel loops [Figure 1]a. An ultrasound examination of the abdomen showed a left retroperitoneal space-occupying lesion with the bowel loops displaced toward the periphery. Further evaluation with contrast-enhanced computed tomography (CT) abdomen showed a large, well-defined, lobulated, fat density lesion in abdomen and pelvis with epicenter in retroperitoneal region on the left side displacing bowel loops toward the right side and left kidney medially likely represents lipoblastoma [Figure 1]b. The patient was planned for surgery. The laparotomy was performed, which revealed a huge yellowish tumor arising from the retroperitoneal space occupying the left of the abdomen and displacing kidney and bowel medially. By careful dissection, the tumor was removed; it weighed 6 kg [Figure 2]a and [Figure 2]b. The patient had an uneventful recovery. The histological examination of the excised specimen confirmed lipoma.

Figure 1: (a) X-ray abdomen showing soft-tissue shadow in the left side of abdomen and bowel displaced right side; (b) contrast-enhanced computed tomography images showed a mass in abdomen

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Figure 2: (a) Intraoperative view showed after (b) complete excision of the lipoma, excised specimen

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Discussion

Lipomas are the most common soft-tissue tumors that are encountered in clinical practice. Lipoma of the abdominal cavity, a benign neoplasm of mature fat cells, usually presents as an asymptomatic abdominal mass or progressive abdominal distention. In a series of 190 retroperitoneal tumors in infants and children, only two were lipomata.^[2] Till 1979, only 12 cases of retroperitoneal lipoma in children, diagnosed in the first decade of life, were reported in the literature.^[2],[3]

Clinically, these lipomas produce few symptoms and therefore tend to become large before being discovered.^[4] The only report of malignant degeneration was by Kretschmer, who removed a large lipofibrosarcoma from a 2-year-old girl.^[3] Lipoma of the abdominal cavity usually presents as an asymptomatic abdominal mass or progressive abdominal distention. Lipomas are sometimes detected incidentally as an intraperitoneal radiolucent fat density mass, on a CT scan. Ultrasonography may present a confusing picture in some cases of retroperitoneal lipoma. Two cases of histologically proven giant retroperitoneal lipomas, evaluated by CT and sonography, appear to be similar on CT, but they exhibit different echographic patterns sonographically.^[5]

An abdominal cerebrospinal fluid pseudocyst is an uncommon complication of ventriculoperitoneal shunts. Ozkan et al. reported a case of pseudocyst in a 6-year-old female child with abdominal distension mimicking ascites for 2 weeks. Sometimes, it becomes very difficult to identify the source of these cysts which mimics ascites and misdiagnosed as ascites.^[6]

Conclusion

Retroperitoneal lipoma is rare in children. The long-term behavior of retroperitoneal lipoma in children is not well-defined as compared to adults, due to the inadequate number of cases; therefore, a long-term follow-up is essential in children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgement

We would like to acknowledge Dr. Annu Bhandari, Senior Professor, Department of Radiology, SMS Medical College Jaipur, Rajasthan, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Ukita S, Koshiyama M, Ohnaka M, Miyagawa N, Yamanishi Y, Nishimura F, et al. Retroperitoneal lipoma arising from the urinary bladder. Rare Tumors 2009;1:e13.
2.	Weitzner S, Blumenthal IB, Moynihan PC. Retroperitoneal lipoma in children. J Pediatr Surg 1979;14:88-90.
3.	Wolk DP, Schuster KM. Retroperitoneal lipoma in a child. Arch Surg 2000;136:343-4.
4.	Bowen A, Gaisie G, Bron K. Retroperitoneal lipoma in children choosing among the diagnostic imaging modalities. Paediatr Radiol 1982;12:221-5.
5.	Brazilai M, Biterman A. Two sonographic presentations of giant retroperitoneal lipomas. J Diagn Med Sonogr 1997;13:140-2.
6.	Özkan A, Kaya M, Okur M, Kocabay G, Kocabay K. Huge abdominal pseudocyst following ventriculoperitoneal shunt mimicking massive ascites. Duzce Med J 2013;15:52-4.