Raja Thalapathi, Kothapalli Sushmitha, Palaniyandi Velmurugan, Sekar Hariharasudhan, Krishnamoorthy Sriram
Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Urology, Sri Ramachandra Institute of Higher Education and Research, chennai, IND.
Cureus. 2025 Jul 26;17(7):e88828. doi: 10.7759/cureus.88828. eCollection 2025 Jul.
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.
一名56岁女性，伴有左腰部疼痛、间歇性呕吐和全身乏力，同时患有新诊断的糖尿病和高血压。初步评估发现左季肋部有一个质地硬、边界不清的肿块。肾脏、输尿管和膀胱的对比增强磁共振成像及计算机断层扫描显示的特征与左肾上腺髓样脂肪瘤相符，遂行腹腔镜肾上腺手术。手术中发现肿块与脾脏、胰尾和左肾粘连，因此将腹腔镜手术转为开放手术。术后患者出现有恶臭的引流物，提示胰管漏。于是，该患者接受了急诊脾切除术、胰体尾切除术、脾裂伤清除术及横结肠造口术。组织病理学检查显示为囊性肿块、慢性胰腺炎和炎症，无恶性迹象。临床、检查及手术结果均不提示肾上腺肿块，强调在诊断腹膜后问题时需要团队协作及仔细评估。
