Diffuse steatonecrosis - presenting as an obscure abdominal mass - a diagnostic dilemma

Binay Kumar, Upasna Chachra, . Bhuvan


Diffuse steatonecrosis secondary to acute / gangrenous pancreatitis presenting as vague abdominal mass is difficult to diagnose and requires special method / techniques for demonstration of fatty acid crystalloids. We report a case of acute abdomen with palpable lump. On emergency exploratory laprotomy a large thick jumbled up omental mass was revealed adhered to parietal wall along with complete pancreatic necrosis. Biopsy show diffuse fat necrosis of pericolic fat, omentum / mesentry with involvement of gut submucosa and birefringent saponified fatty acid crystalloids were demonstrated. Steatonecrosis may cause diagnostic dilemma and should be considered as differential diagnosis in appropriate clinical setting.


Pancreas, Steatonecrosis, Submucosa, Xanthogranulomatous reaction

Full Text:



Kusum D, Semlani S, Deshpande. Migration of steatonecrosis in pancreatitis. Indian J Pathol Microbiol. 2006;49(4):546-7.

Keen CE, Buk SJA, Brady K, Levison DA. Fat necrosis presenting as obscure abdominal mass: Birefringent saponified saponified fatty acid crystalloids as a clue to diagnosis. J Clin Pathol. 1994;47:1028-31.

Agarwal S, Nelson JE, Stevens SR, Gilliam AC. Diffuse erythema as an unusual presentation of pancraetic fat necrosis. J Cutan Med Surg. 2002;6(1):16-8.

Cannon JR, Pitha JN, Everett MA. subcutaneous fat necrosis in pancreatitis. J Cutan Pathol. 1979;6(6):501-6.

Saag KG, Niemann TH, Warner CA, Naides SJ. subcutaneous pancreatic fat necrosis associated with acute arthritis. J Rheumatol. 1992;19(4):630-2.