I was unable to get the link I pasted to work correctly because you’d have to register with the site and decided to just put the info here instead since I could also put the images here as well. Because each image is at the max size I will put the first here and the second two in the next posts below.
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 multiple air fluid levels suggestive of acute intestinal obstruction. 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 terminal ileal loop twisted around the omental band and adherent 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 sigmoid colon (Figure 1). The body was soft to firm in consistency (resembling a boiled hen’s egg) and attached (parasitized) to the omentum (Figure 2). In addition, part of the appendices epiploicae, attached to his sigmoid colon, were calcified with constricted stalks. The peritoneal loose body was largely parasitized to the omentum with a separate feeding vessel supplying it from the omentum.
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Macrograph showing location of the ‘boiled egg’ (Giant loose peritoneal body) in the abdomen which was something of a surprise to the operating surgeon during exploration and adhesiolysis for acute intestinal obstruction.
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Macrograph showing giant peritoneal loose body parasitized to omentum. The macrograph clearly shows the giant loose body attached to omentum and a separate twig from omentum supplying to loose peritoneal body.
The body was an oval shaped mass, measuring 7 cm in length and 5 cm in width, and weighed 74 g. On the cut surface, it had classic appearance like a boiled egg, with a distinct white peripheral part and yellow central part (Figure 3). The white part was smooth and soft in consistency while the central yellow part was slightly firm in the periphery and hard (calcified) at the central point. The surfaces were smooth and shiny. On histological examination, it consisted of laminated strands of a fibrinoid substance with a large amount of proteinaceous material in the peripheral white part (boiled albumin with a high collagen deposition) and saponified fat with calcification in the central yellow part.
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Macrograph of giant loose body (cut surface) showing peripheral white & central yellow portions resembling a boiled egg.
Our patient did well post-operatively; he resumed his oral diet on the third post-operative day. He was discharged from the hospital five days after the operation.