75-year-old male, with prior history of perirectal lipoma, presented to the emergency department with nausea, vomit, sharp intense abdominal, peritectal and lower back pain. Patient refers pain for the past several months, interfering with ADL, with worsening in the last 2 days. CT scan reported a fat-containing right pelvic lesion, extending into the right obturator foramen, measuring approximately 9.8 x 5.3 x 6.2 cm. causing mass effect on the rectum and bladder. CT guided biopsy was consistent with mature fibroadipose tissue, however a well differentiated liposarcoma/atypical lipomatous tumor was not ruled out.
Decision was made to perform a robotic excision of the mass. The dissection of the mass was challenging due to the difficult deep location, close to lumbar plexus and vascular strictures. Upon finalizing the excision a deep venous bleeding was identified and ultimate controlled with 3-0 prolene suture. Pathology reported mature adipocytic tumor, but could not exclude well-differentiated liposarcoma.
Post-operative the patient developed urosepsis, was managed with IV atb and discharged home on POD 20. Follow-up at 2 months patient referred feeling better, mobile, with improvement of the pain.