Sudden Abdominal Pain Research Articles

S3327 Angiosarcoma Presenting as Hemorrhagic Shock: A Rare Diagnosis of Liver Lesions in a Young Patient

Introduction: Angiosarcoma is an aggressive tumor and rare in young healthy patients. Angiosarcoma is associated with exposure to arsenic, vinyl chloride, and oral contraceptives1. This is an unusual case of angiosarcoma in a young patient presenting with an acute abdomen from hemorrhagic shock. Angiosarcoma has poor prognosis and even removal and transplantation of the Liver is no sufficient 1. It is important to include angiosarcoma in the differential for patients presenting with acute abdomen and explore aggressive medical therapy along with surgical resection. Case Description/Methods: A 19-year-old male with no past medical history presented with sudden severe diffuse abdominal pain, difficulty breathing, nausea, vomiting, and diarrhea. FAST exam showed large volume of free fluid in the abdomen. Initial labs showed elevated liver associated enzymes, Hgb 5.4, lactic acidosis, fibrinogen 171. CT of abdomen and pelvis showed hepatomegaly with multiple small hypervascular lesions in liver [Figure 1]. Massive transfusion protocol was initiated, and he subsequently required emergent exploratory laparotomy with 3L of old-appearing blood drained. Intraoperatively, the liver was found to be multinodular, woody, enlarged, and cirrhotic with fresh heme. Final surgical pathology showed angiosarcoma with atypia over epithelioid hemangioendothelioma. Patient continued losing blood and required a hepatic angiogram with embolization. He continued to worsen, developing acute liver failure. Patient continued to decompensate and eventually required palliative care. (Figure) Discussion: Angiosarcoma often presents in elderly patients with nonspecific symptoms such as abdominal distention, abdominal discomfort, weight loss, and fatigue2,3,4. Differentiating liver tumors such as hepatoma, adenoma, or vascular malformations on imaging is challenging and surgical resection is essential. Average survival of patients with untreated liver angiosarcoma is approximately 6 months and it increases by 2 years with treatment2,3,4. The standard treatment for liver angiosarcoma is surgical resection. Liver transplant is not indicated because of the high recurrence rate and poor prognosis2,3,4. There are no standardized treatments for patients presenting with hemorrhagic shock besides embolization and resection. More treatments need to be explored for aggressive treatment for hepatic angiosarcoma, as this case highlights a healthy 19-year-old patient dying one month after initial diagnosis with limited options for therapeutic intervention.Figure 1.: CT Abdomen and Pelvis with multiple hypervascular lesions.

Management of snake bite during third trimester of pregnancy with coagulopathy and delivery of a live baby in resource-limited setting in Nepal: a case report

ABSTRACTWe reported a case of snakebite in an 18-year-old woman, Gravida 2 Para 1+0 in the third trimester of pregnancy who presented with pain and swelling over the left hand and forearm and vaginal spotting. The laboratory investigations revealed coagulopathy attributed to green pit viper envenomation. On the fourth day of admission, the patient developed sudden abdominal pain and massive per vaginal bleeding with haemorrhagic shock, most likely abruptio placentae. In Nepal, no anti-snake venom has been developed for green pit-viper. So, she was managed conservatively, including blood transfusion, and delivered a single live female baby without any foetal complications. The patient was discharged along with the baby after 8 days of hospitalization. This case demonstrated that vigilant observation and appropriate resuscitation with fluids and blood products could save mother and baby in pit viper envenomation cases in settings where specific anti-snake venom is unavailable.

Study of Generalized Peritonitis in Children at the Hospital Fousseyni Daou of Kayes: Mali

Introduction: Peritonitis is an acute inflammation of the peritoneum; it is a surgical emergency in children, as in adults. It is still common in underdeveloped countries because of the delay in diagnosis. There are primary and secondary peritonitis. The main symptom is violent and sudden abdominal pain in children. The objectives were to determine the hospital frequency of peritonitis, to describe the clinical and therapeutic aspects, to evaluate the mortality of peritonitis. This was a retrospective study that took place in the pediatric surgery department from January 2019 to December 2021; using patient records. All patients operated for peritonitis from 0 to 15 years old were included in this study. Results: During this study, we performed 650 surgeries, including 23 cases of peritonitis, or 3.53% of the surgeries. The ages were between 4 and 15 years old, the male sex was predominant, i.e. 65.21%: 15 cases. The average consultation time was 7 days. The clinical signs were dominated by abdominal pain in 100% of cases, asthenia and deterioration in general condition. All the patients had benefited from a biological assessment, the widal was positive in 12 cases. Abdominal X-ray without preparation and abdominopelvic ultrasound were performed in all patients. Abdominal X-ray without preparation objectified 6 cases of pneumoperitoneum, water levels in 10 patients. Ultrasound showed 16 cases of appendicular peritonitis, i.e. 69.56%. All patients underwent laparotomy and we found 16 cases of appendicular peritonitis 69.56%, 5 ileal perforations i.e. 21.73%, 1 perforation of the gallbladder i.e. 4.34% and tuberculous peritonitis confirmed by pathology 4.34%. The postoperative course was simple in 65.21%, parietal suppuration was observed in 21.73% of patients. We had recorded 3 cases of death or 13.04%.

Acute abdomen due to anaphylactic intestinal edema associated with systematic mastocytosis: a case report

BackgroundAmong various anaphylactic conditions resulting in acute abdomen, mast cell activation disorders, although rare, are included in the differential diagnosis.Case presentationThis report describes a 63-year-old Caucasian man who was brought to the emergency room with sudden onset abdominal pain, vomiting, and diarrhea, with breathing difficulty, and with facial swelling after quarrelling with an acquaintance. Computed tomography showed edematous and swollen intestines, consistent with splenomegaly. Physical findings included maculopapular cutaneous mastocytosis. He also had a long history of repeated episodes of anaphylaxis requiring occasional epinephrine auto-injector administration; however, the precise cause of anaphylaxis was previously undetermined. Blood tests showed high serum concentrations of soluble IL-2R and tryptase, suggesting mast cell-related disease. Subsequent biopsies of his bone marrow and cutaneous rash confirmed the diagnosis of systemic mastocytosis (SM).ConclusionSM was diagnosed in a patient with acute abdomen who visited the emergency room.

EP-449 Gall Bladder Torsion - A twist in tale

Abstract Introduction A 90 year old lady presented with history of sudden onset abdominal pain. The pain was continuous, severe with a tender abdomen. Methods Blood investigations were not conclusive. A CT of the abdomen revealed a possible torsion of the gall bladder around its axis with impending gangrene. She went on to have a successful emergency laparoscopic cholecystectomy. Results A work up and successful surgical intervention with an extremely unusual gall bladder presentation of torsion.

Findings of Abdominal Imaging in Patients with COVID-19 - Part 1: Hollow Organs.

Since COVID-19 has spread worldwide, the role of imaging for early detection of the disease has become more prominent. Abdominal symptoms in COVID-19 are common in addition to respiratory manifestations. This review collected the available data about abdominal computed tomography (CT) and ultrasonography indications in hollow abdominal organs in patients with COVID-19 and their findings. Since abdominal imaging is less frequently used in COVID-19, there is limited information about the gastrointestinal findings. The most common indications for abdominal CT in patients with COVID-19 were abdominal pain and sepsis. Bowel wall thickening and fluid-filled colon were the most common findings in abdominal imaging. Acute mesenteric ischemia (AMI) was one of the COVID-19 presentations secondary to coagulation dysfunction. AMI manifests with sudden abdominal pain associated with high morbidity and mortality in admitted patients; therefore, CT angiography should be considered for early diagnosis of AMI. Ultrasonography is a practical modality because of its availability, safety, rapidity, and ability to be used at the bedside. Clinicians and radiologists should be alert to indications and findings of abdominal imaging modalities in COVID-19 to diagnose the disease and its potentially serious complications promptly.

Generalized peritonitis secondary to spontaneous rupture of the urinary bladder in a diabetic patient: A case report.

Introduction and importanceSpontaneous rupture of the urinary bladder (SRUB) secondary to emphysematous cystitis(EC) in diabetic patients is extremely rare. Clinical presentations are often non-specific and display the signs and symptoms of peritonitis. The diagnosis is usually made after exploratory laparotomy.Case reportA 70-year-old diabetic woman presented to the emergency department with sudden diffuse abdominal pain and hematuria of six hours duration. Physical examination revealed generalized peritonitis. Multi-slice abdominal and pelvic CT scans showed free air and fluid in the abdominal cavity. After proper resuscitation, the patient was transferred to the operating room for exploratory laparotomy. A 2 cm full-thickness bladder rupture was noted at the dome of the bladder, which was repaired.Clinical discussionWe noticed free air in the urinary bladder wall postoperatively in the CT scan, which is the radiological sign of EC. The Pathology result was in concordance with the diagnosis.ConclusionsSRUB in patients with poorly controlled diabetes and EC is highlighted in this case study. Urinary bladder rupture secondary to EC should be considered When a diabetic patient with a history of urinary symptoms presents with an acute onset of abdominal pain suggestive of peritonitis. Uneventful recovery from SRUB is dependent on early diagnosis and treatment.

A case report and review of acute cholangitis with septic shock induced by Edwardsiella tarda

BackgroundEdwardsiella tarda (E. tarda) is a gram-negative facultative anaerobic bacterium. Gastroenteritis is the most common manifestation of E. tarda infection. However, parenteral infections can occur in immunodeficient hosts, as well as hepatobiliary diseases, malignancies, and/or diabetes. The prognosis of sepsis caused by E. tarda is very worse, with a mortality rate of 38%. We report the occurrence of acute cholecystitis with septic shock and E. tarda bloodstream infection.Case presentationA 64-year-old male with acute cholecystitis secondary to hepatitis B virus infection showed fever and sudden upper abdominal pain. On arrival, right upper abdominal pain, nausea, vomiting, fever, and jaundice were observed. Computed tomography showed common bile duct stones and gallbladder stones. Choledocholithiasis with acute cholangitis was diagnosed and treated surgically. Due to septic shock, a blood culture was assessed showing E. tarda as the main pathogen. Choledocholithotomy, T-tube drainage, cholecystectomy, and intravenous antibiotic treatment after the operation. The patient recovered smoothly after the operation.ConclusionsAlthough E. tarda infection is extremely rare, it can cause rapid episodes of rapidly progressive and life-threatening disease, as well as intestinal and parenteral infections. If necessary, early surgical treatment of parenteral infection should be considered and antibiotics should be used in time.

Achievement of a 136-day delayed-interval delivery of a second twin with minimum intervention

The rate of multiple pregnancies in the past three decades has increased dramatically. Twin pregnancies have a higher risk of pregnancy loss owing to premature birth. Although the premature delivery of the first twin is usually followed by spontaneous birth of the second twin, there are ways to delay the delivery of the second twin to enhance survival and neonatal outcomes. However, there is insufficient evidence to support the role of any interventions such as cerclage, hospitalization, tocolytics, and/or antibiotics. As a result, the management of delayed interval for the delivery of the second twin varies depending on each case. The purpose of this study was to report the obstetric components of a successful delayed-interval delivery, with an emphasis on the current conflicts around the active management of the delayed interval delivery of the second twin. A case of a 40-year-old, G5P4, woman who had three cesarean sections is presented. She got pregnant with a dichorionic diamniotic twin. At 17 weeks of gestation, she developed sudden severe lower abdominal pain, vaginal bleeding, and spontaneous expulsion of the first fetus weighing 179 g. After delivery of the first twin, the vaginal bleeding became minimal, and the cervix was reconstituted soon, so cervical cerclage was not offered. The umbilical cord of the first fetus was cut at the level of the external cervical os, and the placenta was retained. She received intravenous fluids, anti-D prophylaxis, paracetamol, and antibiotics. The patient was keen to continue with the pregnancy and was informed about the risks and benefits. The management was mainly an outpatient basis after an initial short hospital stay of 6 days before being discharged (upon her request); during the follow-up, she did not develop any clinical manifestations of maternal infection. She was subjected to ANC at the outpatient clinic every 2 weeks, where vaginal culture, complete blood count, prothrombin time, and C-reactive protein levels and serial ultrasonography were checked consistently. The fetus showed adequate growth. After 136 days, she delivered by elective cesarean section a male baby weighing 2850 g at 37 weeks of gestation with good recovery. In certain situations, delayed delivery of the second twin of diamniotic dichorionic twin pregnancy may be a safe, simple with less interventions, and effective option to improve pregnancy outcome.

Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights.

Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.

Was It a Case of “Flatbush Diabetes” with Severe Hypertriglyceridemia?

AbstractWe present a case of a morbidly obese 27 years male patient who was admitted with sudden onset abdominal pain and crashed into diabetic ketoacidosis as new-onset diabetes and discuss the possible etiology of this combined picture of acute pancreatitis and severe hypertriglyceridemia. Flatbush diabetes was, meanwhile, thought of due to his morbid obesity that in turn raised our suspicion of acute insulin-requiring type 2 diabetes mellitus versus T1 diabetes mellitus. Ketosis-prone diabetes or Flatbush diabetes is a syndrome in which diabetes commences with ketoacidosis in patients who are glutamic acid decarboxylase and antiislet cell antibody negative and have no known precipitating causes. They are usually middle-aged, overweight, or mildly obese, and in many reports, they are likely to be male with a family history of type 2 diabetes mellitus; they present with new-onset severe hyperglycemia and ketosis or frank diabetic ketoacidosis. After intensive initial insulin therapy, many patients become insulin-independent and can be well controlled on diet plus oral medications or, more rarely, diet alone.

Extratubal secondary trophoblastic implants (ESTI) following laparoscopic bilateral salpingectomy for ectopic pregnancy: problems that have been neglected for a long time

Background: Extratubal secondary trophoblastic implants following laparoscopic salpingectomy is an extremely rare form of persistent ectopic pregnancy. These cases usually result in a small amount of vaginal bleeding and sudden lower abdominal pain thereby presenting with hemoperitoneum in emergencies. Owing to the urgency of hemoperitoneum and the uncertainty of the location of persistent ectopic pregnancy after laparoscopic salpingectomy, the risk of reoperation is increased. It is necessary to prevent in first surgery and diagnose these cases in the early following up phase. Methods: We report a case of 26-year-old woman, gravida 3, para 0, presenting a little vaginal bleeding and slight lower abdominal pain after laparoscopic bilateral salpingectomy for more than 1 month. The patient’s serum β-HCG was still high (3981 mIU/ml), and no abnormalities were found through auxiliary examination (ultrasound, abdominal CT, and pelvic MRI). Results: Finally, emergency laparoscopy revealed many blue purple nodules on the surface of ovaries, small intestine, omentum, and periumbilical peritoneum, with a diameter of 3–20 mm. The lesions were completely removed as far as possible. Pathology showed trophoblastic proliferation and β-HCG soon decreased to negative after this operation. Conclusion: Therefore, it is important to follow up serum β-HCG even after salpingectomy and avoid iatrogenic dissemination of trophoblast tissue through careful operation.

Spontaneous transvaginal intestinal evisceration in case of long-standing uterine prolapse

BackgroundTransvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral.Case presentationWe report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness.ConclusionsEarly detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team.

Sudden Fatal Abdominal Pain in an Old Man With Chronic Constipation

Question: A 66-year-old man presented with a 4-hour history of sudden severe abdominal pain. The medical history was notable for a chronic constipation. Vital signs were temperature 38.6°C; pulse, 98 beats per minute; respirations, 23 breaths per minute; blood pressure, 107/86 mm Hg; and an oxygen saturation of 80% on room air. Physical examination showed abdominal distension, tenderness, and signs of peritonitis. A computed tomography scan of the abdomen revealed a pneumoperitoneum in the upper abdomen, a large amount of feces around and loading in the sigmoid colon, and several large fecalomas in the distal sigmoid colon (Figure A, B, arrow).

Uterine rupture of a patient with rudimentary horn pregnancy at 26th gestational weeks.

Introduction and importancePregnancy of Rudimentary Horn is a type of ectopic pregnancy, that is recognized almost always during surgical treatment of a rupture of the rudimentary horn. This is an obstetric case diagnosed preoperatively by magnetic resonance imaging (MRI).Case presentationWe report the case of a 19-years-old primigravida patient with rupture of rudimentary horn in 26th gestational week. The patient presented with sudden onset severe abdominal pain in the emergency room. Intraabdominal free fluid is detected. To evaluate the etiology of free fluid and location of the gestational sac, an abdominal magnetic resonance imaging (MRI) scan was planned. The decision of emergent laparotomy is made because of sonographic detection of abdominal excessive -concentrated- free fluid, abdominal tenderness, and 2 points decrease of hemoglobin value in the control hemogram. A rudimentary horn pregnancy and fundal rupture of the rudimentary part of the uterus are diagnosed during the surgical procedure. A baby -live- weighing 450 g was delivered. The ruptured rudimentary horn and same-sided tuba uterina were surgically removed.Clinical discussionRudimentary horn pregnancy is a rare ectopic pregnancy. Diagnosis is difficult clinically, even with diagnostic imaging modalities. Identifying both cornuas systematically in all patients increases the detection rate. The absence of continuity between the gestational sac's lumen and the cervical canal on imaging is an important finding.ConclusionDue to the serious maternal and fetal complications, its detection at an early week may be life-saving.

Complete Uterine Rupture: A Case Report

Abstract Background: Uterine rupture during pregnancy is a considerable obstetric complication. The presence of a previous uterine scar is the most significant risk factor. Early clinical diagnosis is paramount to maternal and fetal survival. Case Report: A 36- year-old woman, gravida 2 para 2, presented with sudden acute abdominal pain at 38 weeks of gestation. The patient had a history of cesarean delivery one year ago. Ultrasound scans showed an empty endometrial cavity and fetus outside the uterus. Emergency laparotomy was performed, a live baby boy weighing 3.420 kg was delivered, and the uterine disruption was repaired. Conclusion: Increasing trends in the cesarean section may lead to a higher number of uterine ruptures. The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of appropriate medical team and equipment. Health professionals caring for pregnant women should be alert for the symptoms and risk factors of uterine rupture.

Rupture of Spleen During Pregnancy with Intrauterine Fetal Death Mimicking Rupture Uterus: A Case Report

Background: Splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed event. The splenic rupture during pregnancy is difficult to diagnose because it shares signs and symptoms with other conditions such as uterine rupture and abruptio placentae. Case report: We report a case of a 26 years G3P2L2 who had splenic rupture following accidental fall from the stairs. She presented with acute abdominal pain with hemoperitoneum and intrauterine fetal death. Ultrasonography confirmed moderate amount of free fluid and fetal demise without any evidence of retroplacental clots. She was taken up for emergency laparotomy with a provisional diagnosis of rupture uterus. On laparotomy, massive hemoperitoneum due to splenic injury was noted. Hence, Splenectomy was done and she recovered without further complication. Splenic rupture should be considered in cases of trauma to the abdomen during pregnancy because of the risk of severe haemorrhage, shock, and possibility of pregnancy loss. The aim of the article is to highlight the fact that rupture of the spleen is an unusual but serious cause of acute abdominal pain in pregnancy and is associated with both maternal and fetal complications. Conclusion: Sudden abdominal pain, pallor, and hypotension following any trauma may be a sign of splenic rupture. Resuscita-tion of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality. Hence, it should be one of the differential diagnoses in addition to abruptio placentae and uterine rupture in suspected cases of haemorrhagic shock.

Role of Radiology and Laparoscopy in Childhood Peptic Ulcer Perforation.

Objective Peptic ulcer disease (PUD) in children is an uncommon disorder. An estimated 1.3 percent to 20 percent of people die from perforated peptic ulcers (PPU), a PUD consequence. Using a database, we assess the prevalence and prognosis of PPU in patients. We also do radiological and laparoscopic operations for PPU in young patients. In pediatric patients, sufficient accumulation of knowledge about laparoscopic repair is at the level of case reports. This study aims to assess the results in pediatric cases operated for PUP by open or laparoscopic surgery and determine the role of computed tomography (CT) in diagnosing PUP. Methods Data was collected from the Department of Pediatric Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Turkey, from 2015 to 2020. Patients under 18 years of age who were operated on for PUP between 2015 and 2020 were divided into two groups. Group 1 involved those patients operated by laparoscopic surgery, whereas Group 2 involved those used by open surgery. Both groups were retrospectively evaluated in terms of demographic data, clinical findings, preoperative-intraoperative findings and surgical methods (open or laparoscopic), duration of surgery, duration of nasogastric intubation, time of return to oral feeding, length of hospital stay, and postoperative complications. Results 18 patients consisting of 15 boys and 3 girls were included in the study. Group 1 involved 10 patients, whereas Group 2 involved 8 patients. In Group 1, the symptom onset period was 1.6 ± 1.9 days, and in Group 2, it was 6.6 ± 6.1 days. In the erect abdominal radiographs (AXR) of 10 (58.8%) patients, the air was under the diaphragm. Six patients whose erect AXRs showed no attitude under the diaphragm but had abdominal pain and acute abdominal manifestation were given abdominal computed tomography (CT) scanning. In all patients with PUP, laparoscopic/open surgery involves primary suturing and repair by omentoplasty (Graham patch). The mean operative time was 87.0 ± 26.3 minutes in Group 1 and 122.5 ± 57.6 minutes in Group 2. The mean length of hospital stay was 3.9 ± 1.3 days in Group 1 and 5.8 ± 2.1 days in Group 2. Neither group developed any major surgical complications. Conclusions Adolescents with a history of sudden onset and severe abdominal pain may present with peptic ulcer perforation even if there is no known diagnosis of peptic ulcer or predisposing factor. In cases suspected of PUP, it is vital to order and carefully examine erect AXR, which is an easy and inexpensive method. Computed tomography should be the first choice in patients without free air in ADBG but whose anamnesis and findings match peptic ulcer perforation.

Rotura esplénica como consecuencia de mononucleosis infecciosa

We present the case of a 16-year-old male who asked in an emergency department for sudden abdominal pain since many hours and loss of consciousness. Few days before, he had odynophagia and high fever. Leucocytosis with lymphocytosis predominance in analysis and splenic rupture with hemoperitoneum in echography and computerized tomography was shown. The treatment consisted in urgent surgery (splenectomy), which was uneventful. Splenic rupture is an emergency in young patients, so it is essential to do a good anamnesis and physical exploration to avoid mistakes with a potentially fatal outcome.

Pedunculated Intraperitoneal Lipoma Presenting as Ovarian Torsion: A Case Report

A lipoma is a very common (prevalence 39%) benign soft tissue tumour that is composed of mature fat. Lipomas, though common on external surface of body, also have been reported in mediastinum, chest wall, thorax, retroperitoneal areas and pelvis. In Gastrointestinal Tract (GIT), lipomas are mainly found in the submucosa and subserosa of the small and large intestine. An eightyear-old female child presented with a feature suggesting torsion of the dermoid ovarian cyst. The clinical features included sudden abdominal pain, vomiting and other symptoms suggesting a differential diagnosis of appendicitis or an ovarian cause. Serum markers for carcinoma were normal. The Contrast Enhanced Computed Tomography (CECT) showed a right iliac fossa fat density with few internal septations and Magnetic Resonance Imaging (MRI) confirmed the torsion of the pedunculated mass and histopathological examination showed the mass as lipoma. The site of the lipoma, presented in this case, is rare. Though the presentation of intraperitoneal lipoma is rare, this should be considered as differentials in young patients presenting with features of ovarian torsion. The presentation of intraperitoneal lipoma especially in young patient is rare which is mostly an incidental finding in a laparotomy and mostly present as a case of obstruction or abdominal pain.