Accidental finding of simlex urachal cyst during ultrasonic abdominal examination

Abstract Introduction/Objective Mesenteric cysts are rare intra-abdominal lesions in adults. However, with the advanced imaging techniques and laparoscopic techniques, they are more often being identified and resected when clinically significant. There is a lack of detailed information in histopathology (except as case reports) since mesentery is generally neglected in our organ-based textbooks. The aim of our study is to highlight the importance of identifying and classifying mesenteric cystic lesions; they are not all that simple. Methods We performed a retrospective search on all mesenteric cysts submitted as excisions in our electronic database from 2013-2019. We classified them as per the de Perrot (PMID: 11053936) classification with modification. Results Our search showed: A. Lymphatic origin-11 (lymphangioma-10, Lymphangioma hamartomatous-1, associated with LAM-0), B. Mesothelial origin-68 (Benign mesothelial cysts-57, multilocular mesothelial cyst-11), C. Enteric origin- 3, D. Urogenital origin (Urachal cyst, mullerian inclusion cyst)-9, E. Mature cystic teratom-2, F. Pseudocyst-12, G. Epithelial cyst (not urogenital)- 11 (a/w LAMN-3, MCN-4, Mucinous cystadenoma-4), H. Associated with carcinoma-2. Case illustration: A 61-year-old male presented with worsening dysphagia, emesis and hiccups. A CT scan showed a 21.2 cm cystic mass with at least one septation (Fig 1). The cyst was resected. On gross pathological examination, the cyst measured 18 cm in greatest dimension with a thick, rough, tan-brown capsule. Microscopic examination showed a fibrous capsule, and cyst wall composed of numerous lymphatic vessels (CD31 positive) and prominent smooth muscle proliferation (Desmin positive). Scattered lymphoid aggregates were also present throughout the cyst wall. No definite epithelial lining was identified and was suspected to have been denuded. HMB-45 immunostain was negative, ruling out association with LAM. The final diagnosis of a Lymphangiomyoma, hamartomatous was rendered. Conclusion Though most of the mesenteric cysts are benign, some of them are significantly important such as Lymphangiomyoma (esp secondary to LAM), MCN, those associated with LAMN etc. and identifying and differentiating from their mimics has distinct clinical implications.

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Gastric antral vascular ectasia in children, rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-236896 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236896

Author(s):

Matthew Pizzuto ◽

Sarah Ellul ◽

Mohamed Shoukry

Keyword(s):

Gastrointestinal Endoscopy ◽

Abdominal Ultrasound ◽

Clinical Findings ◽

Evidence Based ◽

Gastric Antral Vascular Ectasia ◽

Perianal Area ◽

Rare Presentation ◽

Vascular Ectasia ◽

Blood Tests ◽

Abdominal Examination

A 14-year-old boy, a known case of perinatal hypoxic cerebral palsy, presented to paediatric emergency with acute melaena and blood staining around feeding gastrostomy site. Physical examination revealed pallor, but no signs of distress with an unremarkable abdominal examination. Routine blood tests revealed normochromic. Abdominal ultrasound scan and Meckel’s scan were unremarkable. The patient underwent examination under anaesthesia of the perianal area and joint upper and lower gastrointestinal endoscopy. Streak-like gastritis with no signs of active bleeding lesions were noted and patchy areas of colitis involving the descending and sigmoid colon and the rectum. All clinical findings and evidence-based diagnosis matched gastric antral vascular ectasia. He was successfully managed conservatively with elemental hydrolysed feeding formula.

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An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst

Medicina ◽

10.3390/medicina57050495 ◽

2021 ◽

Vol 57 (5) ◽

pp. 495

Author(s):

Ioana Anca Stefanopol ◽

Magdalena Miulescu ◽

Liliana Baroiu ◽

Aurelian-Dumitrache Anghele ◽

Dumitru Marius Danila ◽

...

Keyword(s):

Meckel’S Diverticulum ◽

Surgical Excision ◽

Cyst Formation ◽

Meckel's Diverticulum ◽

Urachal Cyst ◽

Macroscopic Appearance ◽

Surgical Interventions ◽

Bladder Dome ◽

Low Sensitivity ◽

Tract Infections

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

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Dysuria, Rebound Tenderness, and a Palpable Mass—A Ticking Time Bomb

Military Medicine ◽

10.1093/milmed/usab180 ◽

2021 ◽

Author(s):

Tyler Miklovic ◽

Philip Davis

Keyword(s):

Emergency Department ◽

Case Reports ◽

Pubic Symphysis ◽

Subsequent Treatment ◽

Urachal Cyst ◽

Significant Morbidity ◽

Palpable Mass ◽

Rebound Tenderness ◽

Patient Reported ◽

Middle Aged Adult

ABSTRACT A 37-year-old male presented to the emergency department with the complaint of periumbilical abdominal pain, radiating to just above pubic symphysis. The patient reported that the pain was worse with urination and associated with chills and nausea. This case reports discusses the Emergency Department (ED) course and subsequent treatment of a patient found to have an infected urachal cyst, a previously asymptomatic embryological anomaly in an otherwise healthy middle-aged adult male. This is a crucial diagnosis to make in order to avoid the potential for significant morbidity and/or mortality, given the unlikely symptomatic source.

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An infected urachal cyst is a rare differential diagnosis for an acute abdomen in adult female: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20161345 ◽

2016 ◽

pp. 1655-1656

Author(s):

Ramesh Bettaiah ◽

Shraddha Kurkuri ◽

M. Chandramouli

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Acute Abdomen ◽

Adult Female ◽

Urachal Cyst ◽

Rare Differential Diagnosis

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Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature

BMC Surgery ◽

10.1186/s12893-020-01021-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hind S. Alsaif ◽

Ali Hassan ◽

Osamah Refai ◽

Khaled Awary ◽

Haitham Kussaibi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Malignancy ◽

Ct Guided ◽

Case Presentation ◽

Hepatic Tuberculosis ◽

Ct Guided Biopsy ◽

History Of ◽

Abdominal Examination ◽

Peripheral Arterial ◽

High Index Of Suspicion

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. Case presentation We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. Conclusion A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

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Extraovarian primary seromucinous cystadenoma masquerading as mesenteric cyst

BMJ Case Reports ◽

10.1136/bcr-2020-240414 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240414

Author(s):

Kishor R J ◽

Bhuvaneshwari Harikrishnan ◽

Naveen Alexander ◽

Veena Bheeman

Keyword(s):

Lower Abdominal Pain ◽

Interesting Case ◽

Mesenteric Cyst ◽

Lumbar Region ◽

Normal Limits ◽

Mesenteric Border ◽

Contrast Enhanced ◽

Laparoscopic Excision ◽

Abdominal Examination ◽

The Right

We report an interesting case of extraovarian, primary seromucinous cystadenoma, which presented as a mesenteric cyst. A 31-year-old woman came with complaints of lower abdominal pain for 2 years, which is intermittent and aggravated during the menstrual cycle. On examination, her vitals were within normal limits; per abdominal examination revealed 7×7 cm mass in the right lumbar and right hypochondrium with well-defined margins. A Contrast-enhanced whole abdomen done showed a thin-walled of cyst of size 7×8×9 cm in the right lumbar region abutting and replacing the mesenteric border of ascending colon suggesting of mesenteric cyst. Patient underwent laparoscopic excision of mesenteric cyst. Histopathology revealed seromucinous cystadenoma without ovarian stroma.

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