Abdominal mouse in a patient with endometriosis post GnRH therapy

Peritoneal loose bodies (PLBs) are uncommon incidental findings seen on laparoscopy or exploration in a range of patients. The reasons for the occurrence of these entities and their origin are many. They may even be seen following GnRH therapy in endometriosis, as in our case. CASE REPORT A 26-year-old unmarried woman (body mass index: 29 kg/m2) complained of pelvic pain and dysmenorrhea. On pelvic examination, her cervix was pulled up with bilateral forniceal tenderness. On ultrasonography, her left ovary showed two 4 cm × 4 cm endometriosis cysts and a negative sliding sign. She was placed on three cycles of GnRH analogs and on laparoscopy showed the presence of PLBs in the pelvis [Figures 1 and 2].

PLBs are also known as abdominal mice. They may be from a range of sources, including calcified myomas or necrotic fatty tissue from the mesentery.[,] These are usually small, measuring 0.5–2 cm, but can, in some cases, be larger, about 5 cm in size. They are usually asymptomatic. Microscopy of these fatty loose bodies demonstrates dystrophic calcifications and necrosis. PLBs are frequently located in the pericolonic region or near the adnexa anteriorly. The differential diagnosis can be late-stage epiploic appendagitis, mesenteric panniculitis, or omental infarction. More often, they go unnoticed on ultrasonography and are only seen on laparoscopy or laparotomy. Epiploic appendagitis that has undergone fat necrosis and detachment is a common cause based on a literature search.[,] It results due to infarction and detachment of epiploic appendages. This entity rarely needs surgical intervention. To conclude, we demonstrate the occurrence of PLBs or abdominal mice in a patient with endometriosis after GnRH therapy. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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