Mesenteric Pseudocyst Causing Intestinal Obstruction

ABSTRACT

Mesenteric pseudocyst has a fibrous cystic wall without an endothelial lining. It can develop from an inflammatory reaction or from trauma. This lesion is difficult to diagnose preoperatively, and it is rarely symptomatic except when it is complicated by bleeding, rupture or infection. A 66-year old male presented with generalized abdominal pain for 3 days. In his past medical history, an appendectomy was done forty years ago. Three months after the operation, a mass was palpated in the left lower quadrant and size of the mass had gradually increased. Physical examination revealed a distended abdomen with diffuse tenderness. The non-tender mass, which was about 10 cm in size, was palpated in the left lower abdomen. A simple abdominal x-ray showed a mechanical obstruction of the small bowel. A CT scan showed a 10x9 cm sized cystic mass with a partially enhancing cystic wall. Surgical exploration revealed the 13 cm sized mass in the distal ileum about 40 cm proximal from the ileocecal valve, and the adjacent ileum was obstructed by this mass. The mass was a thick walled cyst that contained a non-clotting bloody material. Histopathological examination indicated that the cyst wall was composed of fibrosis with neutrophil infiltration, but there was no specific endothelial lining. The final pathological diagnosis was a mesenteric pseudocyst. Mesenteric pseudocyst with obstruction is rare and difficult to diagnosis, but it should be included in the differential diagnosis in the case of intestinal obstruction with mass.