2012 Volume 32 Issue 6 Pages 1075-1078
The patient was a 39-year-old woman. At the age of 37 years, she underwent a radical hysterectomy and intravaginal irradiation for cervical cancer. When she visited her neighborhood hospital with complaints of right lower abdominal pain and fever in February 2010, she was diagnosed as having acute appendicitis. She was then referred to our department. Severe tenderness and peritoneal irritation were found in the right lower quadrant. Abdominal computed tomography revealed a 7×4-cm cyst in the right iliac fossa. An enhanced inflammatory response was indicated by a white blood cell count of 17,700 cells/mm3 and C-reactive protein levels of 7.1 mg/dL. Based on these findings, acute appendicitis with a retroperitoneal abscess was diagnosed, and surgery was performed. Laparoscopic observations revealed a hen’s egg-sized mass with mild inflammation of the covering peritoneum in the right iliac fossa. The mass, which was laparoscopically resected, was a unilocular cyst containing pus-like fluid. The appendix vermiformis was normal and left untreated. A histopathological examination indicated a simple cyst, and cytology of the content fluid did not reveal any malignant cells. A bacterial culture grew Streptococcus agalactiae. Tumors arising from the retroperitoneum account for only 0.2% of tumors occurring in the human body. Although the resection of cystic tumors including those in the retroperitoneum is considered preferable, some studies report that a watchful-waiting strategy can be applied in cases without subjective symptoms. In our case, the cyst was infected, contributing to abdominal pain. Thus, the cyst was laparoscopically resected.
