Clinical case
We present the case of a 44 year old man, whose symptoms began in May 2016 which included abdominal distention for 3 months duration. This was associated with periodic,mild lower abdominal pain which was colicky in nature. Medical treatment was seeked in Indonesia. A CT scan was done which revealed a mass in the abdomen measuring 10x8cm. He was offered surgery however patient refused due to the fear of complications. Over time the abdominal mass enlarged in size which was heavy and restricted patients mobility. There was no bowel or bladder symptoms, nausea or vomiting. No associated repiratory distress or any neurological symptoms. No history of loss of appetite, however the patient noted himself to be losing weight despite the increased size of the mass. Patient is a non-smoker and does not consume alcohol. There is no history of malignancy in the family.
On clinical examination, there was a very large mass occupying nearly the entire abdomen. The mass was firm in consistency with limited mobility. It was not attached to the overlying skin. The overlying skin was stretched with an everted umbilicus.
There was no pallor or jaundice observed. There was no palpable cervical lymph nodes.
The chest was clear and rectal examination was normal.
A repeat CT scan with contrast of the abdomen found a contiguous large intraperitoneal heterogenous hypodense mass occupying the abdominal and pelvic cavity measuring 25.2cm(W) x 17.8cm(AP) x 21.5cm (H).The mass displaces the small and large bowel, with no evidence of intestinal obstruction. Mild ascites is noted. A small calcified nodule is seen in the right lateral lung base,likely a granuloma. Another small nodule of indeterminate nature is noted in the left posterior lung base. The spleen, pancreas, kidneys, liver, both adrenals, bladder and prostate are normal. No pelvic lymphadenopathy. No suspicious bony lesions.