Multilocular Cystic Mass Located in Epigastric Region and Right Area of the Abdomen in an old man

Abstract

A 67-year-old man presented with generalized abdominal pain, abdominal distension, and inability of defecation and gas passage, which persisted for two months. The pain was constant, which was first appeared in the epigastric and right upper quadrant (RUQ) regions but gradually became generalized. The pain intensified by bending and eating food while alleviated by lying. The patient complained of constipation, weight loss, and loss of appetite. He also reported a few times of vomiting after eating. He had no diarrhea, fever, icterus, dysuria, hematuria, shortness of breath, and coughing. There was no blood in the stool. The patient’s medical history revealed an appendectomy in 20 years earlier. He was a chronic smoker without any history of opium and alcohol consumption. In physical examination, he was pale and had bilateral temporal atrophy. His jugular vein pressure was normal. The abdomen was distended and asymmetric with an apparent palpable mass extending to the epigastric, RUQ, and right lower quadrant (RLQ) regions. A surgical scar was seen in McBruny’s point, which must have been from the earlier appendectomy (figure 1). The bowel sounds were hypoactive in all quadrants. Laboratory results were as the following: white blood cell count: 10.6×103/μL, hemoglobin: 12.9 gr⁄dL, platelet: 175×103/μL, prothrombin time (PT): 12.5 sec, partial thromboplastin time (PTT): 32sec, INR: 1, blood urea nitrogen (BUN): 31mg⁄dL, creatinine: 1.24mg⁄dL, aspartate aminotransferase (AST): 24U⁄L, alanine aminotransferase (ALT): 11U⁄L, amylase: 101U⁄L, lipase: 45U⁄L, CRP: 12.2 mg⁄L, and normal levels of electrolytes and urine analysis.