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Images of Memorable Cases: Case 100

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Case_100-pres1-1.jpg Case_100-pres1-2.jpg

Abdominal radiographs of an elderly woman who, in 1954, underwent a barium enema examination because of recurrent abdominal pain. Scattered throughout the abdomen (left image), particularly in the right subdiaphragmatic area (right image), were numerous rounded, calcific densities with radiolucent centers (arrows).

100. Lipogranuloma of the peritoneum

Also known as oil granuloma, oleoma, oleogranuloma, paraffinoma, vaselinoma of the peritoneum, and “soap bubble syndrome.” This patient said that during a cholecystectomy in 1934, the surgeon had poured mineral oil into her peritoneal cavity to prevent adhesions, a practice that began at the turn of the 20th century. The other lipid agents used for this purpose included olive oil, Vaseline, animal fat, and paraffin. With time, however, it became obvious that these substances acted as irritants rather than lubricants. So by the early 1940s or thereabouts, surgeons abandoned this procedure forever.

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