Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):75-78. 10.14701/ahbps.2018.22.1.75.

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

Affiliations
  • 1Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
  • 2Department of Pathology, National University Hospital, Singapore, Singapore.
  • 3Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore. alfred_kow@nuhs.edu.sg

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.

Keyword

Adrenalectomy; Adrenal gland; Laparoscopy; Pseudocyst

MeSH Terms

Adrenal Glands*
Adrenalectomy
Adult
Ambulatory Surgical Procedures
Humans
Laparoscopy
Liver
Magnetic Resonance Imaging
Pathology
Vena Cava, Inferior

Figure

  • Fig. 1 (A) MRI T2-weighted image showing a 7.6×5.7 cm-sized right adrenal cyst. (B) MRI T2-weighted image showing a right adrenal cyst measuring 6.5 cm in width.

  • Fig. 2 (A) A self-constructed glove port for single-incision laparoscopic surgery. (B) Wound protector with a glove port stretching over it.

  • Fig. 3 Adrenal Pseudocyst situated posterior to the liver.

  • Fig. 4 (A) Adrenal Pseudocyst. The cyst wall was devoid of an epithelial or endothelial lining and it was composed of fibrous tissue with haemorrhagic fibrinous material, cholesterol clefts and calcifications. Adrenal parenchymal tissue was identified (Hematoxylin and eosin ×40). (B) Adrenal Pseudocyst (Hematoxylin and eosin ×100).


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