Giant Intraperitoneal Multiloculated Pseudocyst in a Male

Abstract

Intraperitoneal pseudocysts are rare and may be difficult to differentiate from other malignant neoplasms. Reports of occurrences are mainly associated with long-term intraperitoneal catheter use, intraperitoneal catheter infections, or major pelvic surgery in females, although there are few reported incidences without prior trauma. We present a case of a male patient found to have a 19 × 15 × 9 cm intraperitoneal pseudocyst with other multiloculated areas and a history of a right inguinal hernia repair. After a thorough review of the literature, this is the first multiloculated nonpancreatic pseudocyst reported in a male patient.

Figure 1

Large intraperitoneal cystic mass measuring 17.2 × 14.6 × 17.3 cm with displacement of bowel.

Figure 2

Second separate loculated area measuring 3.7 × 10.1 × 3.8 cm measuring 24 Hounsfield units.

Figure 3

Smaller loculated fluid collection within the right midabdomen between the mesocolon of the proximal transverse colon/hepatic flexure and small intestine.

Figure 4

Site of prior right inguinal hernia repair adjacent to the pseudocyst.

Figure 5

Large intraperitoneal mass exposed intraoperatively with adherent omentum.

Figure 6

Intact large cystic mass measuring 19 × 15 × 9 cm with a thick tan-yellow capsule.

Figure 7

Micrograph shows cystic wall composed of fibrous tissue. There are angiogenesis, mild chronic inflammation, and hemosiderin deposits. Hemorrhagic material is seen loosely attached to the luminal surface. H&E section (100x).

Figure 8

High power view of the cystic wall shows reactive fibrosis. The fibroblast contains spindle nuclei with small nucleoli set against a dense collagenous matrix. There are scattered foamy macrophages, lymphocytes, and hemosiderin pigments. H&E section (400x).