Primary peritoneal sarcoidosis causing an omental cake. Academic Article uri icon

abstract

  • Introduction: Omental cake is an ominous sign, and is mainly caused by malignancy. There are many causes of omental cake, of which intraperitoneal tumor spread is the most frequent. In the current article, we describe a case of an omental cake in a young patient, its rare cause, and its histopathological appearance. Case presentation: The patient suffered from severe abdominal pain, and had a CT scan, which demonstrated an enlarged uterus, ovarian cysts, a small hypodense lesion in the liver and suspected peritoneal spread with omental cake. No primary lesion was found in the scan and ancillary tests, and thus a decision was made to perform a diagnostic laparoscopy. In the laparoscopy, numerous white patchy dots were found on the peritoneal surface of the inner abdominal wall, the liver, and the small intestine. A biopsy was taken from the greater omentum. The patient had an uneventful recovery from the surgery. To our surprise, the source of the omental cake in the current case was sarcoidosis. Discussion: Sarcoidosis is characterized by inflammation of tissues resulting in the formation of the small aggregations of cells, or granulomas. Primary sarcoidosis in the GI tract mainly involves the spleen and the liver. Involvement of the peritoneum with sarcoidosis is rare and to our knowledge, has been described only in one other case as the initial manifestation of this disease. The current case is also unique in that this is the first case where involvement of both the peritoneum and lymph nodes is seen. We believe that, the current case, has shown the superiority of laparoscopy as a diagnostic tool, which also gave us an opportunity for biopsy.

publication date

  • January 1, 2013