After several months of noticing that her abdomen was increasing in size – looking like she was pregnant but knowing she was not – my 16 year-old patient finally presented to the hospital with abdominal pain. She was admitted by the medical assistant with the presumed diagnosis of a typhoid induced ileal perforation.
One look at her abdomen and I knew that it was a more chronic problem that was causing her pain. Instead of a generalized distention and tenderness of the abdomen which comes from having intestinal contents pouring into one’s abdominal cavity, she looked more like she was 6 months pregnant. On examination of the abdomen, I could feel a large mass that moved when I pushed it and then bounced back into position. The mass was tender. Otherwise the patient appeared healthy.
We did an ultrasound to confirm our suspicion and found a large mass with both solid and cystic components. We explained her condition to her and asked for her and her family’s consent to take her to surgery.
In the operating room, we delivered a huge cystic mass through the wound. As depicted in the photo, the left ovary and fallopian tube were involved with the mass and had actually been twisted around it’s own blood supply (which is the main source of the pain). We inspected the right ovary and fallopian tube to find that they were uninvolved with this tumor and appeared normal. No other signs of metastasis were found in the abdomen.
However, as I did one more inspection around the abdomen, I examined the liver and small intestine and the colon, I found another smaller, cystic mass attached the the mesentery of the right colon. It was perfectly spherical and soft. It had what appeared to be one large vessel supplying it. I removed the mass and tied off the tubular structure. After the surgery, we inspected both cysts in order to send samples for pathology. The smaller cyst was filled with a thick, green fecal material and the tubular structure was actually a connection to the colon. After reading about my findings, I assume this was a duplication cyst of the colon.
The patient recovered well after surgery and her pain resolved. She even lost 7 kg in the whole hospitalization!
(I am still waiting on pathology results.)