Massive Retroperitoneal Cyst during Pregnancy: Case Report Managed Conservatively by Percutaneous Aspiration and Review of Literature

ABSTRACT

Retroperitoneal cyst is an extremely rare complication of pregnancy. The management of this rare clinical entity is not well understood. An 18-year-old primigravid woman at 11 weeks of gestation with twins presented with complaints of severe nausea and vomiting. Abdominal magnetic resonance imaging showed a 25 × 18 × 10–cm retroperitoneal cyst reaching up to the level of xiphoid processes. No solid component or ascites was seen. She underwent ultrasound-guided percutaneous aspiration of the cyst and 2 L of fluid was removed. The cytology was negative for malignant cells. There was no recurrence of retroperitoneal cyst during the subsequent pregnancy. At 37⁰/₇ weeks' gestation, the patient spontaneously delivered the female fetuses in cephalic and breech presentation. There were only seven cases reported in the literature of retroperitoneal cysts during pregnancy between 1955 and 2008. Retroperitoneal cyst during pregnancy is characterized by its extremely rare incidence and its massive cyst size. Because of the difficulty in surgery due to the gravid uterus and close proximity to major organs and blood vessels, percutaneous aspiration of cyst could be an option during pregnancy.

KEYWORDS

Retroperitoneal cyst - pregnancy - case report - review

REFERENCES

• 1 Bhaumik J, Pembrey M R. A massive retroperitoneal cyst in pregnancy.  J Obstet Gynaecol. 2000;  20 429-430
• 2 Sagili H, Divers M. Cystic abdominopelvic mass in pregnancy: a cautionary tale?.  J Obstet Gynaecol. 2007;  27 732-733
• 3 Fukunaga M, Mistuda A, Shibuya K et al.. Retroperitoneal lymphangioleiomyomatosis associated with endosalpingiosis.  APMIS. 2007;  115 1460-1465
• 4 Hill Jr V L, Woomer D F. Retroperitoneal cyst complicating pregnancy: report of a case.  Obstet Gynecol. 1965;  25 858-861
• 5 Ikeda T, Miyauchi Y, Nishio S, Shimamoto K, Tanji N, Yokoyama M. Primary retroperitoneal lymphocele in a pregnant woman: the first report.  Int J Urol. 2006;  13 445-446
• 6 Ibraheim M, Ikomi A, Khan F. A pelvic retroperitoneal schwannoma mimicking an ovarian dermoid cyst in pregnancy.  J Obstet Gynaecol. 2005;  25 620-621
• 7 Osborne A H. Three cases of retroperitoneal cyst with discussion of X-ray diagnosis by excretory urogram and review of literature.  J Urol. 1974;  112 541-545
• 8 Kier R, McCarthy S M, Scoutt L M, Viscarello R R, Schwartz R E. Pelvic masses in pregnancy: MR imaging.  Radiology. 1990;  176 709-713
• 9 Okur H, Küçükaydin M, Ozokutan B H, Durak A C, Kazez A, Köse O. Mesenteric, omental, and retroperitoneal cysts in children.  Eur J Surg. 1997;  163 673-677
• 10 Kurtz R J, Heimann T M, Holt J, Beck A R. Mesenteric and retroperitoneal cysts.  Ann Surg. 1986;  203 109-112
• 11 Burkett J S, Pickleman J. The rationale for surgical treatment of mesenteric and retroperitoneal cysts.  Am Surg. 1994;  60 432-435