Abstract

Adrenal cysts are rare benign, hormonally inactive diseases that are mainly treated with minimally invasive methods. For giant adrenal cysts a laparoscopic approach is associated with a high complication rate. The authors present a case of a 66-year-old male with a giant left endothelial adrenal cyst, who developed aching pain in the left hypochondrium. CT scan revealed a two-chamber cyst of the left adrenal gland measuring 178 x 98 x 90 mm. The adrenal cyst was significantly displacing the left kidney, the spleen and compressing the renal vessels. The cyst wall contains calcinates and the gallbladder contains a radiopaque calculus. The 24-hour urine normetanephrine level was slightly elevated. An ultrasound-guided percutaneous puncture was made before laparoscopic adrenalectomy and 1000 ml of hemorrhagic fluid was removed. Percutaneous cyst puncture under ultrasound guidance significantly reduced the cyst size, allowing to perform standard laparoscopic adrenalectomy and simultaneous cholecystectomy. This case highlights the effectiveness of the combination of ultrasound-guided percutaneous puncture, laparoscopic adrenalectomy and cholecystectomy for the safe minimally invasive surgical intervention for the giant endothelial left adrenal cyst associated with calculous cholecystitis.

Keywords

  • adrenal cyst
  • percutaneous puncture
  • laparoscopic adrenalectomy
  • ultrasound
  • computer tomography

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