A case report for a diagnostic dilemma of a giant intra-abdominal cyst with an uncertain origin

INTRODUCTION: Giant intra-abdominal cystic lesions are seldom encountered and can post a diagnostic challenge pre-operatively. These often present as increasing abdominal size and from its mass effect. PRESENTATION OF CASE: Here, we present a case of a 58 year-old gentleman with worsening bloating and abdominal distension. A contrasted CT scan of the abdomen revealed a giant intra-abdominal cyst with no definite organ of origin. He underwent a laparotomy and excision of the giant cyst which was not found to be attached to any organ or mesentery. This resulted in resolution of his symptoms and a drastic improvement in his appetite. DISCUSSION: It is often difficult to identify the origin of giant intra-abdominal cysts as pre-operative imaging may show it abutting multiple organs due to its size. Common intra-abdominal cysts include mesenteric, ovarian or peritoneal cysts. A precipitating history such as pancreatitis or surgical implants can suggest pseudocysts. Surgical excision alone is curative but can be difficult due to the size. Controlled intra-operative aspiration can aid in visualization and dissection. CONCLUSION: Giant intra-abdominal cystic lesions cause significant discomfort due to its mass effect. Pre-operative investigations may not identify its cause. Surgical excision is recommended to diagnostic and therapeutic purposes.