Pseudocyst of the Pancreas Masquerading as Adrenal Myelolipoma: Lessons Learned

A 56-year-old female presented with left loin pain, intermittent vomiting, and generalized weakness, alongside newly diagnosed diabetes mellitus and hypertension. Initial evaluation revealed a firm, vague mass in the left hypochondrium. Contrast-enhanced magnetic resonance imaging and computed tomography of the kidney, ureter, and bladder showed features consistent with left adrenal myelolipoma, promoting laparoscopic adrenal surgery. During surgery, it was revealed that the mass was adhered to the spleen, tail of the pancreas, and left kidney, and hence laparoscopy was converted to open surgery. In the postoperative period, the patient had a foul-smelling discharge, suggesting a pancreatic duct leak. Therefore, the patient was taken up for emergency splenectomy, distal pancreatectomy, removal of the splenic fissure, and transverse colostomy. Histopathological examination revealed a cystic mass, chronic pancreatitis, and inflammation, with no signs of malignancy. The clinical, investigative, and surgical findings were not indicative of an adrenal mass, emphasizing the need for a team approach and careful assessment while diagnosing retroperitoneal problems.