Peritoneal Lipomatosis: A Case Report of a 12-Year-Old Boy

Peritoneal lipomatosis is a rare disease in childhood with only two cases previously described in children. We report a further case of a 12-year-old boy diagnosed with peritoneal lipomatosis. His main symptoms were abdominal pain, alternating bowel habit, abdominal distension, and melaena. His diagnostic work up included an abdominal MRI, wireless capsule endoscopy and single-balloon enteroscopy. Peritoneal lipomatosis although rare can be diagnosed in childhood. It is a benign clinical entity with variable manifestations. 1. Introduction Lipomatosis of the peritoneum is a rare disorder with less than 50 cases published to date [1]. There are only two previously reported cases in childhood. We describe a further case of a 12-year-old boy diagnosed with peritoneal lipomatosis. We report the findings of MRI and endoscopic assessment by wireless capsule endoscopy (WCE) and Single-balloon Enteroscopy (SBE). 2. Case Report A two-year-old boy initially presented to his local hospital prominent gastrocolic reflex, bloating, and intermittent changing shape of his abdomen. At the age of 4.5 years he had an abdominal U/S due to ongoing symptoms, which was suggestive of peritoneal lipomatosis. As he continued to complain about abdominal pain, urgency and alternating bowel habit he was referred for further evaluation to our specialist centre at 12 years of age. At the time other symptoms were noted, including intermittent abdominal distention and occasional blood in the stools. Radiological imaging was initially done by MRI scan which revealed widespread peritoneal lipomatosis, encasing the intraperitoneal contents with the lipomatous tissue lying anterior to the liver and stomach. It extended between the right lobe of liver and right kidney and down to the peritoneal cavity into the pelvis. The lipomatosis displaced the bowel loops centrally. The liver spleen, kidneys, and pancreas appeared normal (Figures 1 and 2). The WCE (Pillcam SB, Given Imaging, Yoqneam, Israel) did not reveal any significant abnormalities apart from ill-defined yellowish, round, lesions (Figure 3). As the boys symptoms did not settle he underwent a SBE (Olympus, Tokyo, Japan). Multiple mucosal biopsies were taken which showed normal mucosa from the duodenum to the distal jejunum/proximal ileum. No specific therapy was given, and his symptoms improved spontaneously except for very mild nonspecific abdominal pain. Figure 1: MRI abdomen: lipomatous tissue anterior to the liver and between the right lobe of the liver and the right kidney. Figure 2: MRI pelvis: lipomatous tissue in the pelvis.