Zhou Shengming, Sun Shiqi, Huang Qi, Sun Jiazhong
Department of Endocrinology, The First People's Hospital of Xiaogan, Xiaogan, China.
Department of Clinical Laboratory, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China.
Medicine (Baltimore). 2025 Aug 29;104(35):e44107. doi: 10.1097/MD.0000000000044107.
This study aims to highlight the diagnostic challenges and multidisciplinary management of pelvic lipomatosis (PL), emphasizing imaging's pivotal role and the need for early intervention to mitigate long-term morbidity. With fewer than 200 reported cases, PL remains underrecognized; this case underscores its potential to mimic common gastrointestinal/urinary disorders, advocating for heightened clinical suspicion.
A 42-year-old male presented with a 2-day history of colicky abdominal pain under the xiphoid process, ac companied by nausea, vomiting, and watery stools. Initial external hospital evaluations suggested small bowel obstruction and mesenteric lymphadenitis. Past medical history included abnormal blood glucose levels. Physical examination revealed right upper abdominal tenderness and mild distension.
Imaging studies were pivotal. Emergency abdominal-pelvic computed tomography showed diffuse low-density fat accumulation compressing the bladder and rectum ("pelvic lucency sign"), thickened bladder walls, and enlarged mesenteric lymph nodes. Subsequent magnetic resonance imaging confirmed symmetrical pelvic fat deposition with bladder deformation and elevated bladder base. Laboratory tests revealed mildly elevated bilirubin, C-reactive protein, and triglycerides, but no significant urinary or metabolic abnormalities. Final diagnosis confirmed PL with concurrent prostatitis and pelvic inflammatory changes.
The patient received conservative management, including acid suppression, gastric protection, nutritional support, and symptomatic relief. Surgical intervention was deferred due to symptom improvement. Post-discharge recommendations included dietary control, weight management, and regular follow-up for monitoring disease progression.
Clinical resolution: symptoms resolved with conservative management including acid suppression and nutritional support, with the patient discharged in stable condition. Imaging correlation: magnetic resonance imaging confirmed symmetrical pelvic fat deposition with bladder deformation, while computed tomography demonstrated the characteristic "pelvic lucency sign." Long-term planning: regular monitoring was instituted for potential urinary obstruction and malignancy risk given established associations with chronic cystitis.
PL poses diagnostic challenges due to nonspecific symptoms and often mimics gastrointestinal or urinary disorders. Imaging remains critical for accurate diagnosis. While conservative management suffices in mild cases, surgical options should be considered for severe organ compression. This case underscores the importance of early recognition, multidisciplinary evaluation, and tailored management to mitigate long-term morbidity.
本研究旨在突出盆腔脂肪增多症（PL）的诊断挑战和多学科管理，强调影像学的关键作用以及早期干预以减轻长期发病的必要性。由于报告病例少于200例，PL仍未得到充分认识；该病例强调了其模仿常见胃肠道/泌尿系统疾病的可能性，主张提高临床怀疑度。
一名42岁男性出现剑突下绞痛性腹痛2天，伴有恶心、呕吐和水样便。最初在外院评估提示小肠梗阻和肠系膜淋巴结炎。既往病史包括血糖异常。体格检查发现右上腹压痛和轻度腹胀。
影像学检查至关重要。急诊腹部盆腔计算机断层扫描显示弥漫性低密度脂肪堆积压迫膀胱和直肠（“盆腔透亮征”）、膀胱壁增厚以及肠系膜淋巴结肿大。随后的磁共振成像证实盆腔脂肪对称沉积伴膀胱变形和膀胱底部抬高。实验室检查显示胆红素、C反应蛋白和甘油三酯轻度升高，但无明显泌尿系统或代谢异常。最终诊断为PL合并前列腺炎和盆腔炎症改变。
患者接受了保守治疗，包括抑酸、胃保护、营养支持和对症缓解。由于症状改善，推迟了手术干预。出院后建议包括饮食控制、体重管理和定期随访以监测疾病进展。
临床缓解：通过包括抑酸和营养支持在内的保守治疗症状得以缓解，患者病情稳定出院。影像学关联：磁共振成像证实盆腔脂肪对称沉积伴膀胱变形，而计算机断层扫描显示特征性的“盆腔透亮征”。长期规划：鉴于与慢性膀胱炎已确立的关联，对潜在的尿路梗阻和恶性肿瘤风险进行定期监测。
PL因症状不具特异性而带来诊断挑战，且常模仿胃肠道或泌尿系统疾病。影像学对于准确诊断仍然至关重要。虽然轻度病例保守治疗就足够，但对于严重器官压迫应考虑手术选择。该病例强调了早期识别、多学科评估和针对性管理以减轻长期发病的重要性。
