Uncommon presentation and management of a giant renal cyst abscess: A case report.

Abstract

Background: Renal cysts, especially the cortical type, are a prevalent renal pathology. Most cases are asymptomatic and detected incidentally during abdominal imaging examination for unrelated complaints. They are often benign, but they can rarely transform into cystic renal malignancies. When huge or complicated, especially with an abscess, it may become symptomatic from the renal capsular stretch or inflammation. The open surgical, endoscopic, laparoscopic, and robotic approaches are available for symptomatic renal cyst treatment. This paper aims to report our experience in the management of a case of a giant renal cyst abscess.

Case summary: This is a 26-year-old housewife who was referred to the urology outpatient clinic with a history of left flank pain and swelling for 5 months, with the transabdominal ultrasound scan and computerized tomography scan findings of a huge left renal cortical cyst (Bosniak I). She had associated anorexia, weight loss, nausea, and intermittent fever, which on one occasion was severe and high-grade with chills and rigors. This warranted hospital admission, analgesic and antibiotic therapy. The physical examination was unremarkable at presentation except for a ballotable and mildly tender left lumbar cystic mass. Her vital signs were stable. There was leukocytosis with relative neutrophilia. Further review of the imaging films confirmed the diagnosis of a left giant renal cortical cyst abscess. She was counselled and had open surgical exploration, drainage of 300 mL of pus, cyst unroofing with marsupialization, and was discharged home on the 10^th postoperative day.

Conclusion: Treatment of giant simple renal cortical cyst abscesses should be individualized depending on the pathology in question, the surgeon's experience, patient preference and availability of facilities for endoscopic, laparoscopic or robotic modalities. Notwithstanding open surgical exploration, cyst unroofing and marsupialization are useful modalities in giant renal cortical cyst abscesses and are associated with patient satisfaction.