LARGE RETROPERITONEAL CYST CAUSING EXTRINSIC COMPRESSION OF THE COLON AND CHRONIC CONSTIPATION anasandovalmd@gmail.com

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LARGE RETROPERITONEAL CYST CAUSING EXTRINSIC COMPRESSION OF THE COLON AND CHRONIC CONSTIPATION

6

Mexico

Video

Chronic constipation has an estimated prevalence of 15%. Current guidelines focus on motility disorders and do not recommend routine imaging in the absence of alarm signs. However, extrinsic compression of the colon is a rare but important cause that may be missed without imaging.

A 60-year-old female with history of left donor nephrectomy, hypothyroidism, dyslipidemia, and hyperuricemia presented with abdominal pain initially attributed to gallstones. She reported longstanding constipation (4–5 days between bowel movements), nausea, bloating, and a palpable right lower quadrant mass. FOBT was positive. Colonoscopy showed extrinsic compression of the right colon. CT and MRI demonstrated a large retroperitoneal cystic lesion displacing the colon, suggestive of an inclusion or duplication cyst. Laparoscopic resection was performed with lateral-to-medial dissection, achieving complete removal. The cyst was unrelated to the mesentery or right kidney.

Postoperative recovery was uneventful. Cultures and BAAR were negative. Pathology confirmed a simple retroperitoneal cyst with no evidence of malignancy. The patient is currently asymptomatic with daily bowel movements.

This case highlights the importance of considering secondary causes of constipation in patients refractory to medical therapy. Delayed diagnosis may result in severe complications, lesion growth, or malignant transformation. Retroperitoneal cystic lesions have a broad differential diagnosis and require thorough preoperative evaluation and multidisciplinary management, as demonstrated by gynecology and urology consultations in this case.

https://vimeo.com/1110851801/e4ec2eda8b