Peritoneal mice implicated in intestinal obstruction: report of a case and review of the literature.

BACKGROUND

Peritoneal loose bodies or "peritoneal mice" are asymptomatic and mostly found as "incidentalomas" during intraperitoneal surgery or at autopsy. Implication of these concretions in an acute abdomen is a rare clinical entity.

CASE REPORT: We report the case of a 63-year-old man who presented with small bowel obstruction and two calcified concretions in his pelvis. A computerized tomography scan demonstrated two oval stones near the terminal ileal loop with lumenal compression of the distal small bowel. During laparotomy, two extralumenal glistening stones, measuring 5.8 x 4.5 x 3.7 cm and 5.2 x 4.5 x 3.7 cm, were recovered from the peritoneal cavity. Histologically, the wall showed concentric lamellar fibrosis and calcification, whereas the nucleus displayed the vestiges of membranous fat necrosis; all consistent with diagnosis of peritoneal loose body. All symptoms of bowel obstruction were relieved postoperatively, and the patient had an uneventful recovery.

DISCUSSION: Peritoneal loose body is a histopathologic diagnosis, and most other differentials for calcified intraperitoneal masses can be ruled out during the histologic examination. Surgical removal is recommended because conventional cross-sectional imaging cannot accurately establish the diagnosis.