Abstract
RATIONALE: 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. PATIENT CONCERNS: 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. DIAGNOSES: 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. INTERVENTIONS: 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. OUTCOMES: 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. LESSONS: 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.