A case of retroperitoneal panniculitis with paralytic ileus mimicking a high intestinal obstruction

Abstract

Background: Retroperitoneal panniculitis is a rare, benign, and nonspecific inflammatory disease that affects the retroperitoneal adipose tissue. The specific cause of the disease is unknown. The diagnosis is evoked by computed tomography (CT) and is rarely confirmed by biopsies. Surgical resection is sometimes attempted for complicated forms. A case of a 22-year-old man was presented who was diagnosed with retroperitoneal panniculitis, further, a literature review was also conducted to compare various presentations, etiologies, and potential treatment modalities. Case presentation: A 22-year-old man presented to the emergency department with acute abdominal pain and episodes of postprandial vomiting. A physical examination revealed marked epigastric tenderness accompanied by abdominal distension. The blood examination revealed normal lipase and amylase levels. An abdominal contrast-enhanced CT showed retroperitoneal panniculitis complicated by a paralytic ileus. A self-limiting course of the disease was obtained by adopting a conservative approach. After 20 days, there were no abnormal findings on CT and the patient was referred to internal medicine consultation for additional care. Conclusion: Diagnosis of retroperitoneal panniculitis is a real challenge to surgeons, gastroenterologists, radiologists, and pathologists. Consequently, it is imperative that all hospital practitioners should distinguish between this benign lesion and malignant diseases.