Giant intraperitoneal non-pancreatic pseudocyst: a case report

Abstract

Introduction: Non-pancreatic pseudocysts are rare lesions that typically form from the omentum and mesentery. These cysts have a thick fibrotic wall made up of fibrous tissue and may show signs of calcifications and inflammatory changes. The fluid inside them can vary, ranging from hemorrhage and pus to serous or sometimes chylous content. In most cases, these cysts appear as a result of trauma, surgery, or infection.

Case presentation: A 35-year-old male patient from Ethiopia presented with swelling in his lower abdomen that had been present for 2 years. Initially, the swelling was small but gradually increased in size. The patient experienced frequent urination but no pain or difficulty during urination, urgency, intermittent urination, or blood in the urine. The swelling was initially painless but became painful 2 months prior to his presentation. Abdominal computed tomography scans revealed a well-defined, lobulated peritoneal lesion measuring 16 × 12 × 10 cm, consisting primarily of fluid-filled cysts with a thick, enhancing wall and septa. Additionally, there was a large, heterogeneous enhancing soft tissue component measuring 8 × 6 cm. As a result, the cystic mass was surgically removed in its entirety with partial removal of the bladder wall, and the patient was discharged in an improved condition.

Conclusion: Primary non-pancreatic pseudocysts are extremely rare lesions that must be differentiated from other possible causes of cystic lesions within the peritoneal or retroperitoneal regions. Surgeons should be aware of the potential occurrence of these lesions, which may have an unknown origin.

Keywords: Bladder; Case report; Inflammatory; Non-pancreatic; Pseudocyst.

Fig. 1

The external appearance abdominopelvic mass

Fig. 2

Axial abdominal CT of the patient showing cystic mass

Fig. 3

CT scan showing a predominantly cystic lesion that had an enhancing wall with heterogeneous mural soft tissue

Fig. 4

Sagittal view of the abdominal CT scan of the patient

Fig. 5

Intraoperative picture showing the mass arising from the superoposterior aspect of the bladder

Fig. 6

The gross appearance of the mass after total excision with partial cystectomy

Fig. 7

The gross appearance of the cystic mass (2.8 kg in weight)

Fig. 8

Lymphoplasmacytic inflammatory cell infiltrate and hemosiderin laden macrophages

Fig. 9

Histopathology showing fibrosis and smooth muscle bundles with no epithelium or features of malignancy