Abdominal Pain and Mass

Abstract

A28-year-oldman presentedwith severalmonths of constant, burning upper abdominal pain centered on the epigastrium. The pain was associated with morning nausea and was worsened by food and alcohol. He was given trials of proton pump inhibitors and dicyclominewithno relief. Hehadnoprior chronicmedical conditions.His family historywaspositive for a brother with kidney stones. He was a former smoker but denied current drug or alcohol use. Review of systems was positive for dry throat, gastroesophageal reflux, and frequent headaches. Physical examinationwasnotable for a faintly palpablemidabdominalmass slightly to the left andabove the umbilicuswith localizeddiscomfort topalpation.Ultrasonographyof theabdomenshowed a hypoechoic, hypervascular, solidmass left of themidline (Figure, A). A subsequent computed tomography scan of the abdomen and pelvis demonstrated a left adrenal myelolipoma and a 4.4 × 3.7-cm hypervascular soft tissue mass just left of the midline within the mesentery in close approximationwith the small bowel, centered at the level of the L3-L4 intervertebral disc (Figure, B). A laparotomy was performed and a round, wellcircumscribed soft tissuemass located approximately 90 cm distal to the ligament of Treitz at the base of themesentery was removed intact without the need for bowel resection (Figure, C). Pathologic photomicrograph of the specimen is shown (Figure, D). A B