Laparoscopic resection of a right upper quadrant hemorrhagic mass causing colonic obstruction

Intraabdominal hemorrhagic cystic masses may be of benign or malignant origin. Differential diagnoses include duplication cysts, pseudocysts, gastrointestinal stromal tumors (GIST), and various infectious diseases, amongst many others.

A 40-year-old male with no relevant past medical history presented to the emergency room with acute right abdominal pain. His white blood cell (WBC) count was elevated and CT scan showed a 10-cm cystic mass in the right upper quadrant lodged between duodenum and hepatic flexure, causing obstruction of the ascending colon which was significantly dilated. Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19‑9 were negative and colonoscopy showed a submucosal mass obstructing the hepatic flexure that could not be passed. Endoscopic ultrasound showed a large fluid-filled cyst. Due to poor bowel preparation, no attempts were made to aspirate fluid. He underwent laparoscopic right hemicolectomy with resection of the cyst. The patient recovered well from surgery and was symptom and recurrence free after 1 year. Pathology revealed a hemorrhagic cyst.

It was not possible to establish a definite cause of the hemorrhagic cyst. The patient denied any trauma and had no symptoms preceding the acute hemorrhage. Such lesions should be surgically removed; laparoscopy is a good option in similar cases.