2851 Laparoscopic Unroofing of a Giant Adrenal Pseudocyst During Pregnancy

Abstract

Video Objective Demonstrate the laparoscopic management of a giant cyst during second trimester pregnancy. Setting A 39 years old pregnant woman was referred to our service because of an incidental finding of an apparent simple cyst that occupied all the space between the right iliac fossa and the right hypochondrium. Interventions MRI was performed and apparently the content was liquid only, the well-being of the fetus was corroborated through MRI and obstetric ultrasound. A laparoscopy was performed with transumbilical direct 5 mm trocar technique to access the cavity and pneumoperitoneum was achieved, two accessory ports (5 mm trocar) in the right fossa region and 10 mm trocar in the left fossa region were made, another accessory port was made at the crossing of an imaginary line between the transumbilical port and the left accessory port. The cyst was incised with ultrasonic energy. Citrine liquid was drained and with the armonic scalpel scission and hemostasis careful traction and countertraction was performed to obtain a sample. The sample was extracted using a latex glove as an endobag, afterwards with the harmonic scalpel the unroofing of the cyst was performed to avoid recurrence of the cyst, finally a drain was placed. After 10 days the patient was discharged without surgical or obstetric complications, the hystopathological reported an adrenal pseudocyst, the post-surgery MRI control reported only scarce fluid in the surgery zone; the rest of the pregnancy was uneventful achieving term and delivery of a newborn at 39 weeks. Conclusion Most adrenal pseudocysts are benign and typically asymptomatic; however, if symptomatic the most common presentation is abdominal or flank pain due to compression; multidisciplinary management allows succesfull surgical intervention and excellent outcome for the mother and term delivery. Laparoscopic resection represents the gold standard before 24 weeks of pregnancy.