Non-pancreatic retroperitoneal pseudocyst: a benign disease with non-specific symptoms

Abstract

SUMMARYA 76-year-old man presented with abdominal pain and constipation for 1 month. The pain was dull aching in nature and over the right upper abdomen. He also reported decreased appetite. The patient had no previous attacks of acute pancreatitis or history of trauma. There was no history of fever or melena. On visual inspection of the abdomen, there was a mass effect protruding out of the right mid-abdomen. The mass was approximately measuring 15×15 cm, firm in consistency, non-tender, non-mobile and not moving with respiration. Haematological investigations were normal. Both amylase and lipase were within normal limits. A CT of the abdomen revealed a large welldefined thin-walled cystic lesion measuring 10.3×13.9×14.3 cm in the right lumbar and iliac region without calcification or haemorrhage. A diagnosis of retroperitoneal cyst was made and the patient was taken up for surgery. Histology of the cyst showed the absence of epithelia and was reported as pseudocyst. BACKGROUND

​Primary retroperitoneal pseudocyst: beware of the hoax solid enhancing adrenal mass

“…One case reports a large right-sided retroperitoneal cystic lesion below the liver edge in a 70-year-old man, unrelated to any specific organ and had grown to over 20 cm in diameter 5. This mass was an incidental finding (as with our case); however, a different case of a 76-year-old man, again with a histological diagnosis of a retroperitoneal pseudocyst, presented with abdominal pain and constipation for 1 month, with the lesion grossly palpable on abdominal examination 6. In both these cases, as with our patient, histology of the lesion showed the absence of epithelia and was reported as a retroperitoneal pseudocyst.…”

Idiopathic Retroperitoneal Non-pancreatic Pseudocyst in an Adult Male: Radiological Images and Surgical Video of Laparoscopic Excision

“…Occasionally, calcification of the pseudocyst wall results in an "eggshell" appearance. The contents of the pseudocyst can be hemorrhagic, purulent or serous which unlike pancreatitis is not associated with high amylase and lipase [4][5][6][7]. In our case, the patient had pain mainly in the right iliac fossa with a very low clinical suspicion of pancreatitis.…”

“…Non-pancreatic RPC, on the other hand, is infrequent and has an unknown etiology. It can originate from mesentery, mesocolon or omentum [5].…”

“…Patients usually present with vague abdominal pain, distension, referred pain to legs, lower limb edema, weight loss, and fever. Occasionally, patients have a sudden onset of abdominal pain which occurs due to infection or hemorrhage within the non-pancreatic RPC itself [5,6].…”

“…Surgical options include marsupialization, drainage and cyst excision [6]. Due to the risk of recurrence associated with residual cyst wall, complete excision is recommended [5,8]. Surgical excision can be performed trans-abdominally or retroperitoneally [6,7].…”