Findings of a Gastric Perforation-Related Giant Pseudocyst That Spontaneously Ruptured in a Child.

A 3-year and 7-month-old girl presented with abdominal pain, bloating, and vomiting of 3 days duration. An abdominal X-ray revealed two air-fluid levels in the left upper abdomen (Fig. 1b). An emergency ultrasound scan revealed a large, thin-walled cystic lesion measuring approximately 17×15 × 10 cm and occupying most of the abdominal cavity (Fig. 1a). The echo-free cystic structure extended from the upper abdomen to the pelvis. It had an internal fluid-fluid level and encircled the stomach. A further careful scan revealed a small depression on the posterior wall of the stomach (Fig. 1c). After hospitalization, the child experienced sudden dizziness and abdominal pain during bowel movements. A bedside emergency ultrasound showed free gas and a large amount of free fluid in the abdominal cavity. Additionally, a residual pouch-like echogenicity was seen within the ascitic fluid (Fig. 1d and Videos S1, S2). This suggested that the pseudocyst caused by the gastric perforation had spontaneously ruptured. The following is/are the supplementary data related to this article:eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4MjZhYTc2NmY2YzQ4MGViZWY5OWNjOTRkZDM4MWQxNSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzAyMTk0MDYzfQ.b6QAhy5szq49Fgq5akRKbOfHSV26i1DzWxnkGIemuMiXExtxlqoLCWeHeTcGpf4AQi-r6i_gkjGifatdtRnPkpCw8pkgzW-G0nXsAWGKuTPf5rkEFyQ9YORiJVCKxhq_9MKGrXmbfB_6SLnAIU_CNDtU00qLmLm9-Q2WiL0CPaDEPvehIM5YBhXbEZs6e8kEiD7vg5C1J4mzID0uLLaUILSYOi-GnxFa_rse2B3NIYeedKl1gwgtjE-zxZLjxXZzRIlfOH_ayQLno17WbATitWi1mKGOB8RE-cKjoMhjGpe44btE4-WJ-EJqd3W0X-hpokyc72Ollr5aZvarLjP9yA(mp4, (2.1 MB) Download video eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiMTExOGMyNWI5MGEzZjI0YzA3NDI1NjBkMWNiNWRmNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzAyMTk0MDYzfQ.fBSXVynuxp5raJIZyk5TPiLki6nL77qcEI60cj-bnvlPHNDpr_MwJZkgqNOm3HyvxRb7Iv3yS8Bqq6--M4p851Kb1zcPAr6Ftq9RDAswAMae2PcC0YRmeSo9OwmdELEMY23AHVkREBw6FmlwtO0yqd8cOosfEGLkKds5ZlxNKq906y61UADkkkCJCCULxgKJMHz7lqJ3PQ7tCnzmFoo3xXerKSLZAqfqIE8_xOm086ykhCvsv94Ns9DlBnCd81rwFE0V4vqP8XWz0oVQbxeiNAN3lIpxgN_9LwmzC6DhzqTMFnePtDt6QMNwwolZVwtRbbSyntKjHMvgqmw43vF_hQ(mp4, (2.99 MB) Download video eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4MjZhYTc2NmY2YzQ4MGViZWY5OWNjOTRkZDM4MWQxNSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzAyMTk0MDYzfQ.b6QAhy5szq49Fgq5akRKbOfHSV26i1DzWxnkGIemuMiXExtxlqoLCWeHeTcGpf4AQi-r6i_gkjGifatdtRnPkpCw8pkgzW-G0nXsAWGKuTPf5rkEFyQ9YORiJVCKxhq_9MKGrXmbfB_6SLnAIU_CNDtU00qLmLm9-Q2WiL0CPaDEPvehIM5YBhXbEZs6e8kEiD7vg5C1J4mzID0uLLaUILSYOi-GnxFa_rse2B3NIYeedKl1gwgtjE-zxZLjxXZzRIlfOH_ayQLno17WbATitWi1mKGOB8RE-cKjoMhjGpe44btE4-WJ-EJqd3W0X-hpokyc72Ollr5aZvarLjP9yA(mp4, (2.1 MB) Download video eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiMTExOGMyNWI5MGEzZjI0YzA3NDI1NjBkMWNiNWRmNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzAyMTk0MDYzfQ.fBSXVynuxp5raJIZyk5TPiLki6nL77qcEI60cj-bnvlPHNDpr_MwJZkgqNOm3HyvxRb7Iv3yS8Bqq6--M4p851Kb1zcPAr6Ftq9RDAswAMae2PcC0YRmeSo9OwmdELEMY23AHVkREBw6FmlwtO0yqd8cOosfEGLkKds5ZlxNKq906y61UADkkkCJCCULxgKJMHz7lqJ3PQ7tCnzmFoo3xXerKSLZAqfqIE8_xOm086ykhCvsv94Ns9DlBnCd81rwFE0V4vqP8XWz0oVQbxeiNAN3lIpxgN_9LwmzC6DhzqTMFnePtDt6QMNwwolZVwtRbbSyntKjHMvgqmw43vF_hQ(mp4, (2.99 MB) Download video The child subsequently underwent emergency surgery. A large amount of dark yellow pus was seen on laparoscopy. Two perforations were seen on the posterior gastric wall and on the greater curvature of the stomach (Fig. 2a). Two residual thin-walled cystic masses were also seen (Fig. 2b and c). Her pathology report indicated that a gastric ulcer caused the gastric perforation, and the wall of the cyst was not covered with epithelium (Fig. 2d). Gastric perforations are not rare in children and are usually associated with free gas in the abdominal cavity1; however, in this case, the intra-abdominal cystic mass was huge and no subdiaphragmatic free gas was seen on the initial erect abdominal X-ray. Therefore, the preliminary ultrasonographic diagnosis was a huge mesenteric cyst or an omental cyst2. However, the child was hospitalized due to spontaneous rupture of the cyst, and the bedside ultrasound scan revealed remnants of the shrunken pseudocyst within ascitic fluid, with large amounts of fluid and free gas seen in the abdominal cavity. The additional observation of a small depression on the posterior wall of the stomach during the final ultrasound examination led to a relatively correct diagnosis. The authors have indicated no potential conflicts of interest to disclose.