The lesion was causing displacement of the bowel loops and abutting the anterior abdominal wall with well-maintained planes (Figure 1). The mesenteric vessels were posterior to the lesion. No calcification was evident. Small, rounded, non-enhancing lesions suggestive of simple cysts were seen in both kidneys. MRI showed a large lobulated mass lesion anterior to the left psoas, appearing hypointense on T1WI and heterogeneously hyperintense on T2WI.

Bowel loops were displaced anteriorly. Biochemistry panel was within Inhibitors,research,lifescience,medical normal limits. Figure 1 Heterogeneously enhancing lesion placed anterior to the mesenteric vessels. The patient was taken up for surgery after obtaining fitness for general anaesthesia. On laparotomy, a large, multilobulated tumour approximately 20 cm × 20 cm in size was seen arising from the mesentery of the jejunum. The overlying jejunal loop was densely adherent to the tumour. The tumour was not invading the superior mesenteric vessel or its main Inhibitors,research,lifescience,medical branches.

The rest of the small bowel loops were pushed to the right lower quadrant and the pelvis. The small bowel along with the growth was eviscerated and the main feeding vessel was located. The superior mesenteric vessels were identified AT AN Inhibitors,research,lifescience,medical EARLY STAGE and 2 feet of the jejunum with its involved mesentery was resected just 10 cm distal to the duodenojejunal flexure. A hand-sewn single layer anastomosis was performed to restore bowel continuity. The rest of the visualized viscera and bowel were Inhibitors,research,lifescience,medical grossly normal. No lymphadenopathy was noted. The tumour weighed approximately 1.8 kilograms (Figure 2). The cut surface had a variegated appearance with yellow/tan areas and regions of necrosis. On histopathological examination the specimen showed features suggestive Inhibitors,research,lifescience,medical of pleomorphic sarcoma. The tumour showed

high mitotic activity, marked pleomorphism and intranuclear inclusions. A large number of giant cells were noted with a few showing multivacuolated cytoplasm with peripherally compressed nuclei. Tumour cells were positive for S-100 and negative for SMA/Desmin. Figure 2 Large multilobulated tumour arising from the jejunal mesentery. This patient developed an anastomotic leak on the 5th find protocol post-operative day as evidenced by bilious effluent in the intra-abdominal drain which was controlled by Rebamipide conservative management. The patient was advised postoperative radiotherapy and chemotherapy but he refused any further treatment and left against medical advice. Discussion In comparison with the retroperitoneal liposarcoma, the primary mesenteric liposarcoma is extremely rare and is treated by aggressive surgical management i.e. wide excision with adequate margins (in the absence of distant metastases). Among the malignant mesenteric tumours, lymphoma is most common followed by leiomyosarcoma. Occurring usually in the 5th to 7th decades, the incidence has been seen to be slightly higher in males (15).