Case notes

A 33 year old primigravida at 16 weeks’ gestation presented with sudden-onset sharp abdominal pain. She had no urinary or digestive symptoms and had an uneventful past medical and antenatal history. Marked tenderness was elicited on palpation of the periumbilical region. Laboratory results were normal, but an abdominal ultrasound revealed a 16 cm intraabdominal cyst and confirmed pregnancy ( Figure ).

A , Ultrasonography showed a huge cyst that filled the whole abdominal cavity. B , An image obtained after pneumoperitoneum was produced during laparoscopic surgery did not capture any type of cyst or free fluid consistent with cystic rupture. C , The cyst reappeared after the bladder filled. D , This is a representative histological image of the muscular urachal cyst wall. Evident characteristics are marked fibrosis, moderate edema, dilatation of lymphatic vessels, and infiltration by inflammatory cells, including lymphocytes, within the transitional epithelium lining the cyst wall. Note the presence of focal hemorrhages, which, presumably, are linked to the surgical intervention.

Baud. Phantom cyst. Am J Obstet Gynecol 2010 .

Subtorsion of an ovarian cyst was suspected with an indication for laparoscopic removal. Because of the dimensions of the cyst, right abdominal access with an open laparoscopy was performed instead of a Veress-needle entry into the umbilicus. Surprisingly, after creation of a pneumoperitoneum (12 mm Hg) via right iliac minilaparotomy, laparoscopic examination failed to show any type of cyst or free fluid consistent with cystic rupture. The gravid uterus and surrounding structures were normal.