Benign symmetric lipomatosis (Madelung’s disease) with concomitant incarcerated femoral hernia: A case report

BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.

Benign symmetric lipomatosis of the knees

Benign symmetric lipomatosis（BSL） is a rare disease characterized by the presence of multiple, symmetric and nonencapsulated fat masses in the face. neck and other areas. It is commonly seen in middle-aged Caucasian Mediterranean males, while its etiology is still not clear. The majority of the patients with BSL have a history of alcohol abuse and hepatopathy. BSL of the limbs is very rare. This article reports a unique case of a 60-year-old Chinese woman with involvement of the knees confirmed by the results of magnetic resonance imaging（MR1） and histopathology, which was not described previously in published literatures.

A case of benign symmetrical lipomatosis

A51-year-old man from Inner Mongolia, China was admitted to the Department of General Surgery,Beijing Shijitan Hospital on November 28, 2011, with massive thickening of the neck （Figure I A）. The patient had undergone excision of lipoma like egg size in his double shoulders 18 years before. One year later the tumor rectlrred m situ. The increase of the volume of his neck was observed for over 17 years, and the patient had no history of dyspnea and dysphagia.

Diagnostic and surgical challenges of progressive neck and upper back painless masses in Madelung’s disease: A case report and review of literature

BACKGROUND Madelung’s disease(MD)is a chronic alcoholism-associated metabolic syndrome characterized by symmetrical subcutaneous deposition of adipose tissue in the head,neck,shoulders,back,trunk,and nerve roots of the upper and lower limbs.It is relatively rare in Asian individuals and is prone to misdiagnosis.Herein,we report a case of a patient with MD who had undergone surgical management at our hospital,and we discuss the pathogenesis,diagnosis,and treatment of MD.CASE SUMMARY We report a case of MD in a 65-year-old man of Han descent.The patient had multiple,painless progressive masses for more than five years in the neck and more than 30 years in the upper back.Because of neck mobility limitations and progressive cosmetic deformities caused by the masses,he was admitted to our hospital.He drank approximately 500 mL of liquor per day and smoked heavily for more than 30 years.Contrast-enhanced computed tomography of the neck and chest documented abundant unencapsulated,subcutaneous fatty deposits.We prepared a staged operation plan.The patient was diagnosed with MD;he was advised to abstain from alcohol and was followed up regularly.After a 3-month follow-up,no recurrence of fat accumulation was found in the surgical areas.CONCLUSION This report presents a case of surgical treatment for MD to improve clinicians'understanding of the disease.