English

Abstract

A 15-year-old female patient came with complaint of pain in the left hypochondriac region from past 2 months, which was dull aching, intermittent, aggravated on taking deep breaths, and relieved at rest. Patient also gave history of early satiety. No history of trauma, vomiting, altered bowel habits, fever, night sweats, and weight loss. The patient denied history of any recent travel. On physical examination, a firm nontender mass of size 20×15 cm was palpated in the left hypochondriac region extending to the epigastric, umbilical and left lumbar region with medial border at 5cm right lateral to the umbilicus and finger insinuation was not possible below the left costal margin. The patient underwent ultrasound abdomen which showed large well defined cystic lesion measuring 20X19X30cm, volume 5000-5700cc occupying the left hypochondrium, lumbar, epigastric and umbilical regions with irregular trabeculated wall and internal echoes within. It was seen causing mass effect in the form of posterior displacement of bilateral kidneys, spleen and inferior displacement of bowel loops. Features were suggestive of probable large mesenteric cyst. Computed tomography (CT) of abdomen and pelvis with oral and intravenous contrast was done which showed a large thin-walled abdominal cystic lesion measuring 19x18x22cm of volume approximately 3500- 4000cc occupying the left hypochondrium, epigastric region, umbilical region, reaching up to the lumbar region. It was seen arising from spleen with thinned out splenic parenchyma along its superior, lateral and inferior aspect (claw sign). Anteriorly it was extending to the anterior abdominal wall and abutting the recti muscles. Mass effect was noted on liver and right kidney with displacement of the organs (Figure 1: a, b).