DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.022

Pages: 2497-2500

Background: Omental fat necrosis is an uncommon benign condition that may develop following infarction of the omental fat. When organized and calcified, it can present as a mass-like lesion and mimic other intra-abdominal conditions, particularly after abdominal surgery. [1–4] Case presentation: A 60-year-old woman presented with abdominal pain and a palpable right periumbilical mass five months after cholecystectomy. She was hemodynamically and respiratorily stable, with mildly elevated inflammatory markers. Ultrasound demonstrated an oval, well-circumscribed hypoechoic lesion closely abutting the abdominal wall, containing hyperechoic calcifications with posterior acoustic shadowing. Contrast-enhanced CT showed an oval, predominantly hypodense lesion closely abutting the right anterolateral abdominal wall, containing calcified foci and associated infiltration of the adjacent omental fat, without significant enhancement. Given the history of cholecystectomy, dropped gallstones were considered as an important differential diagnosis. The lesion's close relationship with the abdominal wall also raised the possibility of desmoid-type fibromatosis. Surgical exploration revealed an omental collection containing necrotic tissue and calcified material. No histopathological examination was performed. Based on the imaging and intraoperative findings, organized omental fat necrosis with dystrophic calcification was considered the most likely diagnosis. Conclusion: Calcified omental fat necrosis may mimic dropped gallstones after cholecystectomy and, less commonly, an abdominal wall-associated soft-tissue tumor. Recognition of its imaging characteristics and correlation with the clinical and surgical history may help avoid misdiagnosis. [1–6]