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Published on: February 28, 2025
The disappearing abdominal mass: mesenteric pseudocyst
Jasneet Singh Bhullar1, Paraskevi Orfanou2
1Department of Surgery, Providence Hospital and Medical Centers, 16001 West 9 Mile Road, Southfield, MI 48075, USA. drjsbhullar@gmail.com.
Introduction:
Mesenteric pseudocyst is a term used to describe an abdominal cystic mass with an unknown abdominal origin. They are rare intra-abdominal masses, with a reported incidence of approximately 1 per 100,000 to 250,000 hospital admissions. Most cysts are benign and they may present differently, such as a disappearing mass or a mass that changes locations, thus posing a diagnostic challenge to the clinician.
Case Report:
We describe a case of a 29-year-old woman who presented with a 2-year history of feeling a large mass within her abdomen, which would then disappear for several days and would frequently change position and be felt in different quadrants of her abdomen. Computed tomography scan of the abdomen revealed a large cystic structure, and a computed tomography- guided biopsy was inconclusive. Diagnostic laparoscopic surgery revealed a firm mass arising from the jejunal mesentery; the patient underwent an en bloc resection. Histopathologic examination of the resected mass revealed a rare diagnosis of mesenteric pseudocyst. Mesenteric pseudocyst should be should be kept high on the list of differential diagnoses when a patient presents with a disappearing mass and/or an abdominal mass that changes location.
Insights
Mesenteric pseudocysts are rare abdominal masses that can disappear and change location, posing diagnostic challenges. This case highlights the importance of considering mesenteric pseudocysts in the differential diagnosis of such elusive abdominal masses.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Mesenteric pseudocysts are rare intra-abdominal cystic masses of unknown origin.
- Incidence is approximately 1 in 100,000-250,000 hospital admissions.
- Often present as a diagnostic challenge due to variable presentation, including migratory or disappearing masses.
Observation:
- A 29-year-old woman presented with a 2-year history of a palpable abdominal mass that intermittently disappeared and changed location.
- Initial computed tomography (CT) scan revealed a large cystic structure; CT-guided biopsy was inconclusive.
- Diagnostic laparoscopy identified a mass originating from the jejunal mesentery.
Findings:
- En bloc resection of the mesenteric mass was performed.
- Histopathologic examination confirmed a rare diagnosis of mesenteric pseudocyst.
- The mass was characterized as firm and arising from the jejunal mesentery.
Implications:
- Mesenteric pseudocysts should be included in the differential diagnosis for patients with migratory or disappearing abdominal masses.
- This case underscores the utility of diagnostic laparoscopy when non-invasive imaging and biopsies are inconclusive.
- Accurate histopathological examination is crucial for diagnosing rare mesenteric pathologies.
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