Right adrenal gland pseudocyst masquerading as a large symptomatic hepatic cyst: Single incision laparoscopic (SILS) resection and a review of current literature

Abstract

Adrenal pseudocysts are rare entities, which are usually asymptomatic. Large symptomatic adrenal pseudocysts may cause compressive symptoms. The etiology of these cysts is unknown, although the cyst wall is all lined by fibrous tissue, without any epithelial or endothelial lining. We report a case of a 26-year-old lady who presented with a symptomatic right adrenal pseudocyst measuring 7.6 cm in size. Magnetic resonance imaging confirmed the presence of a right retroperitoneal cystic lesion which was hyperintense on T2 sequencing. An attempted single incision transumbilical laparoscopic surgery (SILS) was performed to excise the right adrenal pseudocyst. However, due to the retro-hepatic nature of the lesion and as the medial wall of the cyst was adherent to the inferior vena cava, an additional 5 mm port was inserted to facilitate retraction of the liver. The post-operative period was uneventful. She was successfully discharged from the hospital as a day surgery patient. The final pathology showed an adrenal pseudocyst.

Pseudoquiste adrenal derecho

“…1 Se identifica a cualquier edad, en especial entre 30 y 60 años de edad. Más común en mujeres, 2,3 pueden ser asintomáticos o presentarse con dolor, síntomas gastrointestinales y una masa palpable. 4 Se han detectado en 0.06 a 0.18% de las autopsias.…”

“…12 Son unilaterales, pero se pueden presentar de forma bilateral (8-15%). 2,12 Dentro de los factores predisponentes se encuentran trauma abdominal, hipoxia neonatal, diátesis hemorrágica, uso de anticoagulantes y aneurismas. 10 La posible etiología del pseudoquiste adrenal incluye: malformación y hemorragia de las venas adrenales a la glándula adrenal por trauma, cirugía o coagulopatía.…”