Abdominal Mass Research Articles

A Large Tuberculous Abscess Mimicking an Abdomino-pelvic Cystic Mass: A Case Report

Introduction: Tuberculosis can involve any part of the gastrointestinal tract or the peritoneum and is the sixth most frequent site of extrapulmonary involvement. The pseudotumoral form is relatively rare and several predisposing factors are mentioned, a significant differential diagnostic problem with malignant tumor pathology is exposed , often considered first when encountering an abdominal or pelvic mass in the context of overall deterioration. Presentation of case: We report a rare case of a huge retroperitoneal TB abscess mimicking an abdomino-pelvic cystic mass. Discussion: Abdominal tuberculosis represents 1 to 2% of all locations and 31 to 58% of abdominal locations. The pseudotumoral form is relatively rare and are uncommon in immunocompetent patients. Tuberculosis abscess can present with variable radiologic features. It is difficult to differentiate it from malignant pathologies. Invasive explorations, such as laparoscopy or laparotomy, play a crucial role in confirming the diagnosis. Peritoneal cavity exploration may reveal whitish granulations, peritoneal nodules, peritoneal hyperemia, filamentous peritoneal adhesions, and intestinal adhesions. Histological examination of biopsies are the key to the diagnosis. The treatment of peritoneal tuberculosis relies on a combined therapy of antitubercular drugs . Conclusion: As TB remains endemic in our country and with the continued increase in multidrug-resistant TB infections, it is important to know various presentations and diagnosis forms features of extrapulmonary TB including TB abscess as the treatment remains basically the same combining anti-tuberculosis drugs and the recourse to surgery.

Meckel’s diverticulum with varied clinicopathological presentations: A case series at a rural tertiary care center

Meckel’s diverticulum (MD), first documented by Wilhelm Fabricius Hildanus in 1598 as a small bowel diverticulum and later detailed by Johann Friedrich Meckel in 1809, is a remnant of the vitellointestinal duct connecting the fetal gut with the yolk sac. It is a true diverticulum, comprising of all the layers of the bowel wall. The commonly cited “rule of 2s” regarding the diverticulum is: Occurs in 2% of the population, has a 2:1 male-to-female ratio, usually discovered by 2 years of age, located 2 feet from the ileocecal valve, and commonly 2 cm in diameter and 2 inches long. Most Meckel diverticula are benign and are incidentally discovered during autopsy, laparotomy, or barium studies. Vitellointestinal duct lining cell being pluripotent, heterotopic tissues such as gastric, pancreatic followed by others might be found. Common clinical presentation in symptomatic cases is gastrointestinal hemorrhages followed by intestinal obstruction, diverticulitis, cystic abdominal mass, patent umbilical fistula, and neoplasm. Clinical signs and symptoms are non-specific simulating other abdominal emergencies and routine radiology is unable to detect the anomaly in rural peripheral centers. Hence, prompt surgical intervention may be needed in emergency cases. Diverticulectomy or ileal segment resection with end-to-end anastomosis is done. Due to the difficulty of diagnosing a pathologic MD pre-operatively, many surgeons recommend prophylactic diverticulectomy in those found incidentally.

Feline ventral abdominal wall angiosarcoma: haemangiosarcoma or lymphangiosarcoma? Clinical and pathological characteristics in nine cases.

Angiosarcomas are rare malignant mesenchymal neoplasms of endothelial cell origin with a predilection to the ventral abdominal wall in cats. Larger case series describing this entity are lacking. Two referral centre laboratory databases were searched for angiosarcoma of the ventral abdominal wall. Nine cases with a histological diagnosis were included. Immunohistochemistry (factor VIII and PROX-1 antibodies) was used to phenotype them as haemangiosarcoma or lymphangiosarcoma. All cats presented with a ventral abdominal mass, five of which were producing a serosanguinous discharge. Eight underwent tumour staging and pulmonary metastases were suspected in one cat (but not histologically confirmed). With histopathology alone, a diagnosis of angiosarcoma and lymphangiosarcoma was made in four and five cases, respectively. After immunohistochemistry, five cases had a haemangiosarcoma phenotype and four had a lymphangiosarcoma phenotype, including two cases of lymphangiosarcoma that were reclassified as hemangiosarcoma. Eight cats received treatment (either surgery with or without adjuvant therapies or medical management alone). Six cats were euthanased due to local disease progression. The median survival time for haemangiosarcoma was 166 days (range 137-381), and for lymphangiosarcoma it was 197 days (range 67-208). Two cats with haemangiosarcoma remained alive for a follow-up period of 329 and 580 days, respectively. Feline ventral abdominal angiosarcomas are rare locally aggressive neoplasms. While histology often provides a diagnosis of angiosarcoma, immunohistochemistry is ultimately required to differentiate between haemangiosarcoma and lymphangiosarcoma phenotypes. Further studies are required to evaluate whether the different phenotypes have an impact on treatment response and outcome.

Intestinal cystic lymphangioma.

A 7-year-old girl, coming from a rural area in Cameroon, presented to the emergency department with a 3-months history of abdominal pain. Her family also reported vomiting and minimal food intake for two weeks. Physical examination showed a palpable and mobile abdominal mass. An ultrasound showed a large intrabdominal multicystic lesion of about 10cm, close to the intestine and with no solid lesions in other organs. A laparotomy was scheduled and a mobile mass dependent on the jejunum was found. The mass caused an intestinal obstruction and was composed of several large cysts with whitish fluid. Excision of the mass and resection of a short segment of small bowel were performed. Intestinal cystic lymphangioma is a rare congenital malformation that normally presents with abdominal pain and distension. Abdominal ultrasonography is the procedure of choice for the diagnosis. Intestinal resection and anastomosis (while the cyst is normally intimate attached to the bowel) is an effective treatment.

Costal Chondroid Tumors Mimicking Intraabdominal Masses: The Pivotal Role of Computed Tomography in Diagnosis.

Teaching Point: Costal chondroid tumors can mimic abdominal masses and, when located in the right hypochondrium, may suggest hepatic origin. Computed tomography is essential to determine their origin and nature and to guide appropriate treatment.

Large Chondrosarcoma of the Lower Rib Presenting as a Cystic Abdominal Mass.

Teaching point: Chondrosarcoma of the lower rib may present with only minimal calcified chondroid matrix and may be misinterpreted as a liver lesion.

Metastatic Desmoplastic Small Round Cell Tumor - A Case Report and Review of the Literature

Desmoplastic small round cell tumour is a rare malignancy most often seen in the abdomen or pelvis of young men. Unfortunately, this disease is usually metastatic at diagnosis and has dismal outcomes. Since 1991, when it was first described as a distinct clinical entity by Gerald WL and Rosai J some 200 cases were reported. All cases are characterized by the chromosomal translocation t (11;22) (p13; q12), which results in a formation of EWSR1-WT1 fusion gene. The diagnosis of IDSRCT is often made with core-needle tissue biopsy specimens of laparoscopy or laparotomy. Immunohistochemical analyses have shown the co-expression of epithelial, neuronal, myogenic, and mesenchymal differentiation markers. Multimodal therapy is usually indicated with chemotherapy, surgery & radiotherapy. We report a rare and unusual case of an extensive abdominopelvic desmoplastic small round cell tumour with liver & lung metastases, in an adolescent male patient from Bangladesh who presented with abdominal mass, pain & hepatomegaly. With various difficulties in diagnosis, we ultimately reached at diagnosis by open biopsy and immunohistochemistry as desmoplastic small round cell tutor. Now patient is on multidrug chemotherapy (modified p6) protocol.

PRIMARY OVARIAN LEIOMYOMA ASSOCIATED WITH MULTIPLE UTERINE LEIOMYOMAS: A CASE REPORT

Leiomyoma is a benign mesenchymal tumour, occurring frequently in uterus. But ovarian leiomyoma is rare, accounting less than 1% of all ovarian tumours. Ovarian leiomyoma is associated with uterine leiomyoma in about 78% of the cases. Being asymptomatic they are often incidentally detected in most of the patients. This is a case of ovarian leiomyoma associated with uterine leiomyomas in a 53 year old woman who had abdominal mass on examination during her regular check-up. Ultrasonography revealed multiple uterine fibroids and a unilocular cyst in right ovary. Total abdominal hysterectomy with bilateral salpingoophorectomy was performed. Gross examination showed left ovary totally replaced by grey-white firm mass. Microscopic features were typical of leiomyoma and was confirmed immunohistochemically. Major differential diagnostic considerations for this tumor in ovary were fibroma, thecoma and leiomyosarcoma. Though rare, ovarian leiomyoma should be considered in differential diagnosis of ovarian solid mass. The immunohistochemical staining with desmin, inhibin, and α-smooth muscle actin are useful to rule out the differential diagnosis.

Prenatal Diagnosis of Fetal Ovarian Cyst. Report of a Case

Background: Prenatal diagnosis of abdominal cysts is relatively common; The ovarian cyst is the most predominant chemical lesion of abdominal masses in female fetuses; however, given the wide variety of intra-abdominal masses, determining the origin of the chemical lesion is the most frequent diagnostic challenge, especially to establish fetal prognosis. Clinical Case: 30-year-old patient, who went to the emergency department for uterine contractions, no prenatal control, during the ultrasound evaluation, polyhydramnios and an intra-abdominal cystic lesion measuring 4.9 x 3.9 cm, without septa and with a thin wall were documented, the area was intentionally reviewed. renal, hepatic, and intestinal; Without involvement of these structures, female genitalia were confirmed, concluding in a probable ovariandependent cyst, admission for resolution of the pregnancy via the abdomen due to pelvic presentation and labor, at birth the diagnosis was confirmed. Conclusions: Timely detection of an intra-abdominal chemical injury and ecological follow-up improve perinatal prognosis.

Rapunzel Syndrome in A 13-Year-Old Girl with Abdominal Pain Presenting to The Pediatric Emergency Department: A Case Report

Trichobezoar is a rare form of bezoar characterized by the accumulation of swallowed hair in the stomach. An unusual form of bezoar, in which the bezoar spreads from the stomach to the small intestine or beyond, is called Rapunzel syndrome. This syndrome is mainly seen in females and is often associated with psychiatric disorders. Trichobezoar usually presents with abdominal pain, early satiety, and nausea. However, it may also present as an asymptomatic abdominal mass or obstruction and pe rforation of the gastrointestinal tract. This diagnosis should be considered in young women with abdominal pain, an epigastric mass, and malnutrition, especially in patients with a history of trichophagy or psychiatric disorder. The case of a 13-year-old girl with Rapunzel syndrome is described. She presented to the emergency ward with a history of abdominal pain, non-bilious vomiting after meal and fluid intake, halitosis, decreased appetite, and weight loss. The patient was treated successfully by laparotomy.

CryptoImperforate Hymen with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girlmenorrhea with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girl

Background: Imperforate hymen is one of the commonest embryological defects of the lower genital tract which occurs due to failure of canalization of the sinovaginal bulb. Its incidence is 1 in 2000 girls. Case Presentation: This case is of a 15-year-old nullipara who presented on account of a 2-month history of recurrent abdominal pain, hesitancy, and primary amenorrhea. Her physical examination reveals a huge abdominopelvic mass about the size of a 26 weeks intra-uterine gestation, and a vagina examination revealed an imperforate hymen. A pelvic ultrasound confirmed a massive hematometra and hemaltocolpos leading to a diagnosis of imperforate hymen. She had a hymenotomy with a cruciate incision to drain the menstrum. Conclusion: Pediatricians and gynaecologists need a high index of suspicion to diagnose this defect for earlier treatment and reduced morbidity due to late diagnosis.

Anaesthetic Management of Retroperitoneal Fetus-in-Fetu - A Rare Case Report and Literature Review

Fetus-in-fetu (FIF) is a rare congenital anomaly caused by the abnormal development of monochorionic diamniotic twins. It usually presents as an abdominal mass in infancy or early childhood. It has to be differentiated from teratoma which has the potential to be malignant. Here, we report a case of a 13-month-old girl child with fetus-in-fetu in the retroperitoneum. In spite of its rare incidence, preoperative diagnosis is possible through various imaging techniques. The child underwent exploratory laparotomy and complete excision of FIF under general anaesthesia. Even though complete resection is curative, long-term follow-up with alpha fetoprotein and beta-human chorionic gonadotropin is essential for monitoring malignant transformation.
 Fetus-in-fetu (FIF), otherwise called as cryptodidymus, is an extremely rare congenital disease caused by the abnormal development of monochorionic diamniotic twins. Its incidence is about 1 in 5,00,000 births and so far, only 200 cases are reported worldwide.[1] FIF occurs when a complete foetus is parasitized by one or multiple incomplete foetuses. It can be divided into two types namely internal and external. If a foetus is inside the body of a host, it is known as internal fetus-in-fetu, it is referred to as an external fetus-in-fetu if it is attached to any surface of the host.
 There is no gender predisposition noted in the incidence of FIF but few articles found a male predominance in the ratio of 2:1.[2] Even though FIF occurs mostly in infants and children < 3 years of age, there are cases reported in adults and pregnant women as well. The oldest patient with FIF recorded in the literature was 47 years old during the time of diagnosis.[3] The most common presentation of FIF is gradually enlarging abdominal mass almost 80% in the retroperitoneum.
 Differentiation from other abdominal tumours including teratomas, is necessary because the latter has potential for malignancy. FIF is usually malformed because of the pressure exerted by the host organs. It can affect their host, hence, early diagnosis and management is crucial. Various imaging modalities like radiography, Color-Doppler ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) have increased the pre-operative diagnosis rate.[4] Treatment of FIF is essentially surgical and prognosis after en bloc resection is favourable. In this article, we present the anaesthetic management of a rare case of retroperitoneal fetus-in-fetu in a girl child.
 The perioperative management of fetus-in-fetu cases is not yet reported anywhere in the literature. The preoperative evaluation and optimisation is very crucial since it reflects on the anaesthetic management and post-operative recovery. Explorative laparotomy in the paediatric age group is quite challenging because of the associated major fluid shifts, blood loss as the mass is located adjacent to the large vessels. Smooth induction and extubation are essential to minimise hemodynamic fluctuations. Meticulous fluid management and adequate analgesia are critical for enhanced recovery. This case report will aid anaesthesiologists in the deeper understanding regarding management of fetus-in-fetu cases.

Limitations in the management of colorectal cancer in sub-Saharan Africa

Colorectal cancer (CRC) was regarded as a rare disease in native West Africans. It is now accepted as an established disease with a rising incidence. The CRC is now known to be a complex tumour with different aetiopathological pathways. With all cancers early detection is important if one aims to cure the patient. A summary of the clinical features include: Unexplained ill-health and anaemia in patients with cancer of the caecum and ascending colon; palpable abdominal mass for colon cancer; rectal bleeding and tenesmus for carcinoma of the rectum; palpable mass on digital rectal examination in at least 75% of cases. The current complete management of this disease involves extirpative surgery and adjuvant treatment with a combination of cytotoxic chemotherapy and tailored therapy. This presentation will look at ways in which seamless management of CRC in this environment is hampered. The ‘PATIENT’ factor: Ignorance (which leads to unfavourable health-seeking behaviour) Poverty (goes for all developing countries) Gullibility (under which falls religion and alternative treatment) Cultural taboos (which lead to refusal of colostomy-based treatments) Aversion of the sequelae of rectal cancer treatment especially in males where up to 30% of patients are under the age of 40 years. Late presentation (effect of 1–5) The ‘COUNTRY’ factor: Politics: inadequate budget for health Workers not enough; current brain drain of doctors, major cancer centres are stretched. Infra-structure: There is a glaring lack of any population screening programme, a lack of public enlightenment messages for awareness and only two government centres have functioning radiotherapy machines. Staplers and cytotoxic drugs have to be imported, thus are expensive and out of reach of the common man. The ‘GENETICS’ factor: The biology of CRC in the native African is different from that of Caucasians and more aggressive. Carcinomatosis peritonei is frequent. There’s also the emergence of unusual metastases to the lungs and spine, bypassing the liver. A summary of the findings by Nigerian researchers on the molecular biology of native Nigerian CRC showed MSI (Not otherwise stated) occurred in 23–53% of Nigerian CRC, MSI-H seen in 28.1–43%. KRAS in 21% while BRAF was seen in 4.5%. The significance of these results may mean that we might not be administering the right combination chemotherapy in over 50% of our patients. Some studies have shown that patients with MSI-H CRC appear to have ineffectual or even detrimental responses to 5FU-based adjuvant chemotherapy. We all know that 5FU is the cornerstone of most of the combination chemotherapy we administer to patients (FOLFOX, FOLFIRI, CapeOX, XelOX). In addition, the 2012 study on BRAF and KRAS in Nigerians by Abdulkareem et al. also suggests that Nigerian patients may benefit more from anti-EGFR therapy (Cetuximab, Panitumumab) than Caucasians. However, cost implications will make prescribing these drugs a mere academic exercise in most Nigerian patients.

Rare Double Primary Malignancies: A Pancreatic Gastrointestinal Stromal Tumor Mimicking as a Metastatic Lesion of Myoepithelial Carcinoma of Parotid Gland

Pancreatic gastrointestinal stromal tumors (PGISTs) are exceptionally rare, accounting for <5% of extra-gastrointestinal stromal tumors (EGISTs) and <1% of malignant pancreatic neoplasms. We present a unique case of concurrent double primary malignancies in a 46-year-old female with a history of recurrent myoepithelial carcinoma of the parotid gland, managed through surgical resection and adjuvant therapy. She presented with an enlarging abdominal mass, initially suggestive of pancreatic metastasis. Immunohistochemical analysis revealed positive staining for smooth-muscle actin (SMA) and CD34 in both parotid and pancreatic tissues. Importantly, CD117 expression was confined to the pancreatic tissue, confirming the diagnosis of PGIST rather than metastasis. Subsequently, a splenic-sparing distal pancreatectomy was performed, followed by immediate imatinib therapy. This case underscores the potential for the coexistence of rare primary malignancies with unique histopathological characteristics and organ involvement. When encountering a newly developed lesion in a distant organ, surgeons must consider the possibility of metastasis to guide therapeutic decision-making. Early diagnosis and appropriate intervention are paramount, particularly in the case of PGIST, given its infrequent presentation and clinical complexities.

Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathology

ObjectivesUltrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to concurrently screen for pneumoperitoneum or other abdominal pathology that could have a similar presentation has not been studied. Our institutional protocol requires the performance of AP supine and left lateral decubitus views of the abdomen prior to ultrasound evaluation for intussusception, providing an opportunity to examine the yield of abdominal radiographs in this setting.Our primary objective was to determine the rate of pneumoperitoneum on screening abdominal radiographs in children undergoing evaluation for intussusception. Our secondary objective was to determine the rate that other clinically significant pathology is found on these screening abdominal radiographs. MethodsWe performed a retrospective chart review of all patients under 6 years of age who had any imaging ordered in our large urban pediatric emergency department to evaluate for suspected intussusception during the calendar years 2018–2020. Results1115 patient encounters met our inclusion criteria. Among 1090 who had screening abdominal radiographs, 82 (8%) had findings concerning for intussusception. Of those not concerning for intussusception, 635 (58%) were read as normal, 263 (24%) showed moderate to large stool burden, 107 (10%) showed generalized bowel distention, and 22 (2%) showed abnormal gastric distention. Individually the remainder of all other findings compromised <1% of encounters and included radiopaque foreign body (8), intraabdominal calcification (4), pneumonia/effusion (3), pneumatosis intestinalis, abdominal mass (2), diaphragmatic hernia (1), rib fracture (1), appendicolith (1), feeding tube malposition (1), and bowel wall thickening (1). In one encounter the patient had a bowel perforation with pneumoperitoneum present secondary to ingestion of multiple magnets. ConclusionsOur study indicates that radiograph-detected pneumoperitoneum is rare in children with suspected intussusception. Constipation is the most common abnormal finding on screening radiographs. Other findings occur in approximately 15% of total cases, some of which require further workup.

Value of computed tomography and abdominal ultrasound for chronic inflammatory complications of diverticular disease

Aim: to evaluate the diagnostic value of computed tomography (CT) and abdominal ultrasound (US) for chronic inflammatory complications in patients with diverticular disease (DD).Patients and Methods: the prospective cohort study included 50 patients with complicated DD. All patients underwent preoperative abdominal CT with intravenous contrast and abdominal US, with further elective bowel resection. The results of CT and ultrasound were compared with morphology of the removed specimens.Results: the sensitivity and specificity for chronic diverticulitis was 66.7% and 95.7% for CT and 100.0% and 95.7% for US. For chronic pericolic abdominal mass it was 94.8% and 90.9% for CT, 94.8% and 100.0% for US; for abdominal abscesses/cavities it was 87.5% and 96.2% for CT and 91.6% and 100.0% for US; for diverticular fistulas it was 87.5% and 100.0% for CT and 87.5% and 100.0% for US. No significant differences were obtained between two diagnostic modalities. A high level of consistency (κ-coefficient 0.71) of CT and US for the diagnosis of inflammatory complications of DD was found. Conclusion: CT and US have a similar high diagnostic value for chronic inflammatory complications of DD. Each of them can be used as a single diagnostic modality or both depending on the clinical case.

Abscess formation of abdominal wall mimicking lymphoma due to Morganella morganii infection in a prepubescent children

Introduction: Morganella morganii infection mainly occurred in elderly people and immunocompromised patients.However, the abdominal wall abscess due to Morganella morganii infection in prepubertal children hasn't been documented.Our presented case is a 4-year-old male patient with a 1 month history of left lower quadrant abdominal mass. Preoperative ultrasonography showed a hypoechoic, heterogeneous mass and the mass wasn't just confined to the abdominal wall, mimicking lymphoma. On CDFI, an image of highly vascularized mass was demonstrated. The patient underwent lump resection of abdominal wall.Postoperative process was uneventful except intermittent haematuria, and bladder sludge and urethral calculus on ultrasonography.By symptomatic treatment, haematuria disappeared and urethral calculus and bladder sludge decreased. Then the patient discharged home. Postoperative histopathology and immunohistochemistry were suggestive of abscess formation and Morganella morganii was isolated finally from the aspirated pus. Conclusion: Therefore, although the abdominal wall abscess due to Morganella morganii infection is rare, it should not be absent in the differential diagnosis of abdominal wall masses in children. Imaging features of abdominal wall masses should closely integrate the pertinent clinical history.

The Incidence of Acute Peritonitis Secondary to Different Sites of Viscus Perforation.

Objective The incidence of peritonitis secondary to viscus perforation will be examined to determine the most common sites of perforation and associated comorbidities. Methods This is a retrospective observational study based on data collected from the King Fahad Hospital of the University (KFUH). This research targeted patients who had viscus organ perforation and the relation of peritonitis secondary to it. The sample was taken from patients under the care of the General Surgery Department from the first of Feb 2016 to the 12th of Sep 2022. The final sample consisted of 450 patients. The method of diagnosis of peritonitis was mainly clinical, and the surgical approach was either through an exploratory laparotomy or a diagnostic laparoscopy. Incidental findings of viscus organ perforation were noted in addition to certain postoperative complications (e.g., adhesions) and hospital stay. Results Analysis of the results showed a significant relation (p<0.001) between viscus organ perforation and peritonitis. The most common comorbidities associated with secondary peritonitis were hypertension (12, 24.5%), diabetes mellitus (10, 20.4%), any abdominal mass (3, 6.1%), and inflammatory bowel disease (1, 2%). However, a chi-square analysis has shown no significant association between peritonitis and the targeted associated comorbidities. Conclusion Perforation of the small intestine carries the biggest association with peritonitis incidence, in addition to comorbidities such as hypertension and diabetes mellitus. Further study to establish the value of these factors might contribute to decreasing the morbidity and mortality of secondary peritonitis.

Late presentation of supernumerary kidney in a 35-year-old man: a case report

The supernumerary kidney is the rarest of all renal anomalies, and few cases have been diagnosed and reported over the years. Supernumerary kidneys are most commonly located on the left side of the abdomen with associated pathologic conditions which include malformations of the upper urinary tract and genital tract. More importantly, it usually presents with either unusual abdominal mass or features of urinary tract infections which might pose diagnostic challenges due to infrequent occurrence. In this case report, we present a 35-year-old man with a right-sided unilateral supernumerary kidney complicated by pyelonephritis. He was treated with antibiotics, and the treatment outcome was satisfactory.

Abdominal fat depots and their association with insulin resistance in patients with type 2 diabetes

Background Asian-Indians show thin fat phenotype, characterized by predominantly central deposition of excess fat. The roles of abdominal subcutaneous fat (SAT), intra-peritoneal adipose tissue, and fat depots surrounding the vital organs (IPAT-SV) and liver fat in insulin resistance (IR), type-2 diabetes (T2D) and metabolic syndrome (MetS) in this population are sparsely investigated. Aims and objectives Assessment of liver fat, SAT and IPAT-SV by MRI in subjects with T2D and MetS; and to investigate its correlation with IR, specifically according to different quartiles of HOMA-IR. Methods Eighty T2D and the equal number of age sex-matched normal glucose tolerant controls participated in this study. Abdominal SAT, IPAT-SV and liver fat were measured using MRI. IR was estimated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Results T2D and MetS subjects have higher quantity liver fat and IPAT-SV fat than controls (P = 9 x 10−4 and 4 x 10−4 for T2D and 10−4 and 9 x 10−3 for MetS subjects respectively). MetS subjects also have higher SAT fat mass (P = 0.012), but not the BMI adjusted SAT fat mass (P = 0.48). Higher quartiles of HOMA-IR were associated with higher BMI, W:H ratio, waist circumference, and higher liver fat mass (ANOVA Test P = 0.020, 0.030, 2 x 10−6 and 3 x 10−3 respectively with F-values 3.35, 3.04, 8.82, 4.47 respectively). In T2D and MetS subjects, HOMA-IR showed a moderately strong correlation with liver fat (r = 0.467, P &lt; 3 x 10−5 and r = 0.493, P &lt; 10−7), but not with SAT fat and IPAT-SV. However, in MetS subjects IPAT-SV fat mass showed borderline correlation with IR (r = 0.241, P &lt; 0.05), but not with the BMI adjusted IPAT-SV fat mass (r = 0.13, P = 0.26). In non-T2D and non-MetS subjects, no such correlation was seen. On analyzing the correlation between the three abdominal adipose compartment fat masses and IR according to its severity, the correlation with liver fat mass becomes stronger with increasing quartiles of HOMA-IR, and the strongest correlation is seen in the highest quartile (r = 0.59, P &lt; 10−3). On the other hand, SAT fat mass tended to show an inverse relation with IR with borderline negative correlation in the highest quartile (r = -0.284, P &lt; 0.05). IPAT-SV fat mass did not show any statistically significant correlation with HOMA-IR, but in the highest quartile it showed borderline, but statistically insignificant positive correlation (P = 0.07). Conclusion In individuals suffering from T2D and MetS, IR shows a trend towards positive and borderline negative correlation with liver fat and SAT fat masses respectively. The positive trend with liver fat tends to become stronger with increasing quartile of IR. Therefore, these findings support the theory that possibly exhaustion of protective compartment’s capacity to store excess fat results in its pathological deposition in liver as ectopic fat.