Coexisting adhesive small-bowel obstruction and giant peritoneal loose body in a surgically naïve patient: a case report

Introduction and importance: Small-bowel obstruction (SBO) is a common surgical emergency, most often caused by postoperative adhesions. However, it may also occur in patients without prior abdominal surgery, commonly referred to as the “virgin abdomen.” In such cases, the causes include congenital bands, inflammation, neoplasms, or rare intra-abdominal entities such as peritoneal loose bodies, which are typically discovered incidentally during imaging or surgery. Case presentation: A 42-year-old man presented with a 3-day history of progressive crampy abdominal pain, bilious vomiting, abdominal distension, and obstipation, with no prior abdominal surgery. Radiography showed dilated small-bowel loops with multiple air–fluid levels, consistent with obstruction. An emergency laparotomy revealed adhesive bands causing SBO. A freely mobile 5 × 4 × 4 cm peritoneal mass was also removed, and histopathology confirmed a giant peritoneal loose body with central fat necrosis, fibrosis, and calcification. Clinical discussion: Peritoneal loose bodies are uncommon and usually asymptomatic, most often arising from torsion and infarction of epiploic appendages that subsequently detach and undergo progressive fibrosis and calcification. Giant peritoneal loose bodies are particularly rare and may mimic intra-abdominal tumors or occasionally produce symptoms due to mass effect. Their diagnosis is frequently established intraoperatively, and surgical removal allows definitive histopathological confirmation. Conclusion: This case highlights an adhesive SBO in a surgically naïve patient, with the incidental discovery of a giant peritoneal loose body. It emphasizes that adhesions may occur without prior surgery and underscores the importance of careful intraoperative exploration to ensure an accurate diagnosis, appropriate surgical management, and definitive histopathological confirmation.