Unusual Presentation of Omental Sarcoma

Hany M Fahmy, MBBChFRCSIFACS, Fadi M Jallad, Raafat Bawadi. Royal Commission Medical Center

Introduction: Although  liposarcoma is common abdominal malignancy, yet mesenteric primary liposarcoma is a very rare disease.

Case presentation: We are presenting a 43 years old Saudi lady presented to our emergency department complaining of sudden onset of epigastric pain of 8 hours duration, radiating to the back associated with vomiting and nausea. Positive history of peptic ulcer disease and was on proton pump inhibitors treatment for the last 3 months. The patient was hypotensive, moderately dehydrated, and with a board like rigid abdomen. Her plain x-ray chest showed air under diaphragm. The patient was operated after resuscitation for exploratory lapratomy. Exploration revealed a perforated duodenal ulcer part one with free peritoneal fluid (bacteria peritonitis). After peritoneal toilet and suction of free fluid, we noticed that firm masses of omentum (omental cack) which bleeds easily on touch are clearly seen. The duodenal perforation was closed by graham patch using a flap from falciform ligament due to abnormal consistency of the greater omentum. No other organ masses could be seen. Biopsy of the diseased omentum was taken. Histopathological study showed primary well differentiated liposarcoma. After improvement of the general condition of the patient, she was referred to oncology center for further management.

Conclusion: Omental sarcoma is a rare malignancy that can present with vague symptoms, usually advanced and may present with unusual clinical presentation.

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