A 4-year-old patient presented with abdominal pain and intestinal sub-occlusion. On physical examination, she had an evident state of malnutrition, marked abdominal distention, non-tender abdomen with resistance to palpation, and two cutaneous lipomas. She underwent ultrasound evaluation, x-ray and Computed Tomography (CT) scan with evidence of a large mass occupying most of the abdominal cavity, from the retro-peritoneum to the anterior abdominal wall and displacing cranially the small intestine (Figure 1).

      She underwent laparotomy with intraoperative finding of a massive lipoma embedded in transverse colon mesentery extending until its origin and into the retro-peritoneum, with hypertrophy of epiploic appendices on transverse, descending and sigmoid colon (Figure 2). The mass was then excised from the colon and the mesentery, with careful dissection along the inferior mesenteric artery. Abdominal lipoma had a weight over 1 kg. Skin lipomas were excised as well. Histological examination of the mass showed regular mature adipocytes without areas of necrosis and no mitoses.

      Final diagnosis was diffused lipomatosis, associated with general malnutrition and lipodystrophy. It is a rare pathology; in the literature only two similar cases are described in association with colonic polyposis in adult age [1,2]. At this time, the patient is in gastrointestinal and nutritional follow up.

Figure 1: Abdominal CT scan - coronal and sagittal sections.

Figure 2: Intraoperative finding: Massive lipoma.