A mobile intraabdominal cystic mass.

A 48-year-old woman presented with chronic intermittent abdominal pain and moderate weight loss. She had a history of fibromyalgia syndrome and vaginal hysterectomy. A 6-month-old computed tomography scan showed a cystic mass 5 cm in diameter with no relation to any solid organ in the left middle abdomen (Figure A). A second CT scan performed after admission showed a mass of 7 cm in diameter now in the right middle abdomen (Figure B). Mobility of the mass was confirmed by sonography because its location was dependent on the position of the patient. Physical examination and standard laboratory tests revealed no abnormalities. Laparotomy revealed a cystic mass adherent to the mesentery of the jejunum (Figure C), which was enucleated without complications. Histology revealed the diagnosis of a benign mesenteric pseudocyst. Mesenteric pseudocysts are a subgroup of the mesenteric cysts, rare intraabdominal tumors subdivided into several groups of distinct etiology.1 The differential diagnosis includes gastrointestinal stromal tumors, teratomas, cystic mesotheliomas, abscesses, and parasitic cysts. Of the symptoms associated with mesenteric cysts,2 our patient exhibited intermittent abdominal pain and moderate weight loss, but no nausea and vomiting. On imaging studies, intraabdominal mobility, a rather thick wall, and sedimentation of the cyst contents, as found in this case, are frequent features of mesenteric pseudocysts.1 Complications include rupture, torsion, infection, and, rarely, malignant transformation.3 Surgical excision by open laparotomy or laparoscopy is generally recommended.2