Abstract
A 36-year-old woman presented to our hospital with the onset of left lower quadrant abdominal pain. There were tenderness and muscular defense in the left lower quadrant of abdomen. Blood examination revealed elevated serum CRP level and increased white blood cell count. Abdominal computed tomography scan showed a well demarcated heterogeneous lipid tumor 77mm in diameter compressing the urinary bladder on the left anterior aspect of the uterus. Transvaginal ultrasonography also revealed a similar tumor, the location of which was consistent with the site of the pain. We thus made a diagnosis of torsion of a left ovarian mature cystic teratoma or a left fallopian tube lipoma. As we could not rule out a possibility of another intraperitoneal tumor, emergency operation was jointly performed by the gynecologists and our surgeons. Laparoscopic examination confirmed the pedunculated tumor of the epiploic appendage of the sigmoid colon with torsion, and the tumor was resected laparoscopically. Histopathological examination showed the mass to be a lipoma with congestion due to the torsion.
It was difficult to identify the tumor location before surgery because few cases were reported about the tumors of the epiploic appendages or intraperitoneal lipomas with torsion. Laparoscopic surgery is extremely important and useful for making the accurate diagnosis and for lessening surgical stress.
