Chronic Right Hypochondrial Pain Due to a Painful Abdominal Wall Lipoma Mimicking Hepatobiliary Disease: A Case Report

TL;DR

A patient's chronic right upper abdominal pain was caused by a lipoma in the abdominal wall, not a hepatobiliary issue.

Contribution

Highlights the importance of considering abdominal wall lipomas as a source of chronic right hypochondrial pain.

Findings

Chronic right hypochondrial pain was caused by a 1 × 1.4 cm abdominal wall lipoma.

Imaging and physical examination confirmed an extramural source of pain, avoiding unnecessary hepatobiliary investigations.

Abstract

Chronic right hypochondrial pain is most often evaluated in the context of hepatobiliary disease. When routine investigations fail to identify an intra-abdominal cause, alternative sources of pain should be considered. We report the case of a patient with long-standing right upper abdominal pain that was exacerbated by movement and local palpation and had been repeatedly assessed for biliary pathology. Initial imaging suggested a possible gallbladder abnormality, which was not reproduced on subsequent examinations. Further focused assessment revealed a localized lesion with sonographic appearances of lipoma within the abdominal wall at the site of maximal tenderness. The size of the lesion was approximately 1 × 1.4 cm. The clinical features and imaging findings were consistent with an abdominal wall source of pain. This report emphasizes the value of thorough physical examination and targeted ultrasonography in patients with persistent right hypochondrial pain to prevent unnecessary investigations and delays in diagnosis.

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