Acquired localised lipoatrophy secondary to transgluteal drainage

Acquired localised lipoatrophy is a focal loss of subcutaneous fat, which is commonly secondary to trauma, injections of medications such as antibiotics or corticosteroids, pressure, previous surgery or panniculitis. We present a case of a patient who experienced focal fat loss in the left gluteal region from a previous left transgluteal drainage of a suspected abscess. There was no medical history of corticosteroid, antibiotic injection or use of highly active antiretroviral therapy. Lipoatrophy occurring as a consequence of a deep pelvic abscess drainage has not been reported in the literature; however, based on the lack of other aetiologies, the diagnosis of acquired localised lipoatrophy secondary to a transgluteal drainage was made in this patient. The aim of this report was to present this rare cause of lipoatrophy that has not previously been described and to acknowledge lipoatrophy as a potential side effect of a deep abscess drainage.

Complicated intra-abdominal focal fat infarction: Emphasis on falciform ligament infarction with abscess formation: A case series

The term “Intra-Abdominal Focal Fat Infarction” (IFFI) encompasses a range of conditions where infarction of fatty tissue is the underlying pathological process, including Epiploic appendagitis, omental infarction, fat necrosis related to trauma or pancreatitis as well as rarer entities such as falciform ligament infarction. Uncomplicated IFFI is usually self-limiting and managed conservatively with oral antiinflammatory therapy. Rarely complications such as liquefaction and secondary abscess formation may arise with associated deterioration in symptoms and signs prompting a change in management including Laparoscopic resection or Percutaneous drainage. We present 3 cases of complicated IFFI with emphasis on the rarer Falciform ligament infarction with abscess formation.

Not Just Fat: Imaging in Abdominal Fat Pathology

Fat in abdomen has diverse distribution and function. Insult to fat due to several causes can result in infarction or necrosis and present as acute abdomen clinically. Intra-abdominal focal fat infarction is one such condition that comprises of epiploic appendagitis, perigastric appendagitis, omental infarction, and torsion of fatty appendage of falciform ligament that have characteristic imaging features. Secondary causes of fat necrosis include pancreatitis or trauma related. Metabolic or responsive fat changes, like hypertrophy and dystrophy, can be diagnosed on imaging especially on computed tomography. Mesentric fat stranding including the mesentric panniculitis spectrum poses diagnostic dilemma and the causes and imaging role are covered in this review. Some infections and neoplasms that preferably affect abdominal fat compartments may mimic benign conditions, although some have specific patterns of involvement.

Falciform ligament appendagitis after Roux-en-Y bypass surgery mimicking acute cholecystitis

Fatty falciform ligament appendage torsion (F-FLAT) is a rare type of intraperitoneal focal fat infarction that involves torsion of a fatty appendage of the falciform ligament. It may cause severe pain, mimicking an acute abdomen, but is typically self-limited and does not require hospitalisation or surgery. As a type of intraperitoneal focal fat infarction, it shares many of the same physiological, clinical and radiological features of epiploic appendagitis. To our knowledge, F-FLAT has not previously been reported in a patient following a laparoscopic Roux-en-Y gastric bypass surgery. Identifying falciform ligament appendagitis is critical because it can prevent unnecessary hospitalisation, follow-up studies and surgery.

Torsion of lesser omentum: A rare presentation of acute abdomen

Intraperitoneal Focal Fat Infarction is a rare cause of acute abdomen. There are two types, Omental Torsion and Epiploic Appendagitis. We present a case of 19 years old male who presented to ER with severe pain in epigastrium and right iliac fossa. Clinical diagnosis of acute appendicitis was made, but epigastric pain remained unexplained. CT scan was reported as non-significant. Diagnostic Laparoscopy picked lesser omental infarction and acute appendicitis. Patient was successfully managed by Laparoscopic Surgery. Symptoms not explained by a single pathology should be thoroughly investigated. CT Scan is the best investigation. Laparoscopic surgery is an effective and safe approach for small segmental omental torsion.