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.