Adrenal Pseudocyst Presenting as Acute Abdomen during Pregnancy

Abstract

Pseudocysts of the adrenal gland are rare lesions, which are usually discovered as incidental findings. Since they are in the majority of cases non-functioning, they become symptomatic only when they are complicated with rupture, haemorrhage or infection. We present a case of a 28-year-old woman in the 26th gestational week, who developed an acute abdomen due to a haemorrhagic pseudocyst of the left adrenal. The patient was submitted to left adrenalectomy. The described case is the third reported case of cystic adrenal lesion discovered during pregnancy and only the first reported case of acute presentation of an adrenal pseudocyst during pregnancy.

Giant hemorrhagic adrenal pseudocyst in a primiparous pregnancy: Report of a case

“…Although percutaneous drainage was tried as a fi rst-line treatment in two patients, it was unsuccessful and complete excision was subsequently necessary. 20,21 After complete excision, the pregnancy resulted in normal delivery in fi ve patients 15,18,20,21,23 and in preterm delivery in one. 22 Therapeutic termination was required in three patients: for fear of fetal teratogenicity because of exposure to radiation and drugs used for resuscitation in two, 6 and because of maternal recurrent pulmonary emboli resistant to anticoagulant therapy in one.…”

“…19 Moreover, three patients were operated on twice because of the diffi culties in identifying the responsible lesion that originated in the retroperitoneum (Table 1). 17,18,23 Papaziogas et al recently reported fi nding a retroperitoneal tumor at an emergency exploratory laparotomy, performed after signs of acute abdomen and circulatory shock developed in their patient. 23 Since there were no signs of active bleeding within the peritoneal cavity, the abdomen was closed and the nature of the tumor was investigated.…”

“…17,18,23 Papaziogas et al recently reported fi nding a retroperitoneal tumor at an emergency exploratory laparotomy, performed after signs of acute abdomen and circulatory shock developed in their patient. 23 Since there were no signs of active bleeding within the peritoneal cavity, the abdomen was closed and the nature of the tumor was investigated. After MRI confi rmed the diagnosis of a large hemorrhagic pseudocyst originating from the left adrenal gland, re-exploration was done, followed by a left adrenalectomy.…”

“…31 Magnetic resonance imaging was used in four of the reported cases, but a correct diagnosis was made in only two, demonstrating the diffi culty in making a preoperative diagnosis during pregnancy. 6,20,21,23 Nonfunctional and asymptomatic small cysts (<6 cm) are sometimes discovered during pregnancy. Percutaneous aspiration can be done if the cyst is less than 6 cm in diameter, if it is not hormonally active, and if there is no suspicion of malignancy.…”

“…6,15,16,[19][20][21]23 The indications for emergency surgery were bleeding with decreasing hemoglobin levels and blood transfusion in four patients; 6,15,16 acute abdomen in one; 19 acute abdomen and circulatory shock in one; 23 and worsening symptoms after percutaneous drainage in two. 20,21 The adrenal pseudocysts were treated surgically by complete cyst excision in four patients, 6,18,22 complete cyst excision with ipsilateral adrenalectomy in six, [15][16][17]20,21,23 and complete cyst excision with partial adrenalectomy in one. 19 Moreover, three patients were operated on twice because of the diffi culties in identifying the responsible lesion that originated in the retroperitoneum (Table 1).…”