Mesothelial Cyst in a Teenager born with Gastroschisis: A case report

Benign mesothelial cysts are rare, and to our knowledge there are no reported cases of benign mesothelial cysts in patients with a history of gastroschisis. A 15-year-old girl with a history of complicated gastroschisis and multiple operations as a child presented to the emergency department with back pain and abdominal bloating that worsened over the course of a year. At the time of presentation, she was febrile, but her basic blood tests were within normal limits. Imaging studies including an abdominal ultrasound, a computed tomography of the abdomen, and a magnetic resonance imagining of the abdomen demonstrated a 31× 21 × 11cm cystic abdominopelvic lesion, the origin of which was unclear. Tumor markers including alpha fetoprotein, CA 125, CA 19–9, beta HCG, carcinoembryonic antigen, inhibin A/B, and lactate dehydrogenase were normal. The fluid was sampled by needle aspiration. Amber fluid with mostly macrophages (72 %) and was obtained. A pigtail catheter was placed, and 2500 ml of clear yellow/brown fluid were drained. She was sent home with the drain and was scheduled for an elective cyst excision but presented to the hospital with a bowel obstruction a few days later. She underwent an extensive laparoscopic lysis of adhesions, drain removal, and partial excision of the cyst wall. The pathology analysis was consistent with a benign mesothelial cyst. No new drains were placed. She recovered well from the operation. At 3 months of follow up she is doing well and has no recurrence of the cyst by ultrasound. She will continue to be monitored with periodic ultrasounds. While rare, benign mesothelial cysts should be on the differential diagnosis of patients with large abdominal cysts, particularly if they have a history of prior abdominal operations.