Laparoscopic Resection of Para-Aortic Mass at the Aortic Bifurcation: An Atypical Presentation of a Tailgut Cyst

TL;DR

A patient with a pulsatile abdominal mass was found to have a tailgut cyst after laparoscopic surgery, emphasizing the importance of differential diagnosis and laparoscopy in complex cases.

Contribution

Demonstrates the successful laparoscopic resection of a large para-aortic tailgut cyst, an atypical clinical scenario.

Findings

Laparoscopic resection of a 8-cm para-aortic mass at the aortic bifurcation was safely performed.

Pathological analysis revealed the mass to be a tailgut cyst, not a neuroendocrine tumor as initially suspected.

The case underscores the importance of considering rare differential diagnoses in abdominal masses.

Abstract

We review the case of a 43-year-old white male who presented with an enlarging pulsatile mass in the periumbilical region. Diagnostic imaging revealed an 8-cm heterogeneous mass abutting the left iliac artery at the aortic bifurcation. Due to the patient’s persistently elevated blood pressure and elevated serum and urine catecholamines, a neuroendocrine tumor was suspected. Laparoscopic resection was performed and was well tolerated. However, the mass was characterized as a tailgut cyst upon pathological examination. This case highlights the utility of laparoscopy for the removal of large para-aortic masses, which can be achieved in a safe fashion by an experienced surgeon. In addition, this case highlights the importance of differential diagnoses in surgeries due to the occurrence of unexpected outcomes.

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