Isolated Congestive Reactional Non-Specific Retro-Peritoneal Adenitis Mimicking a Choledocal Cyst in a Case at the “Luxembourg” Hospital Center in Bamako

The aim of our work was to establish the diagnostic difficulty of isolated nonspecific retroperitoneal congestive adenitis on medical imaging. Patient: This is a 27-year-old patient from a district located 660 km from Bamako with no known medical history or notion of travel. The onset of the disease dates back to 3 years marked by pain in the right hypochondrium and the epigastrium radiating to the back in the form of torsion, of medium intensity associated with periodic vomiting and jaundice. She was referred to the medical imaging department for pain in the right hypochondrium and cholestatic jaundice. The abdominal CT scan with and without contrast injection showed an oval retroperitoneal mass, with regular contours sitting behind the head of the pancreas and in front of the right kidney with its hypo-dense center of density equal to 23 HU measuring 44 × 28 mm, with a thick wall enhanced after injection of contrast product. It was associated with a distended gallbladder with a thin wall and hypo-dense content and a moderate dilation of the intrahepatic bile ducts. Following these examinations, the diagnostic hypothesis of cystic dilation of the common bile duct was retained. Surgery made it possible to cure the retroperitoneal lesion, discectomy of the gallbladder and biopsy of the lesions. The histological examination made it possible to make the diagnosis of isolated nonspecific reactive congestive adenitis. Conclusion: Isolated nonspecific congestive retropancreatic adenitis with a necrotic center poses a diagnostic problem for imaging in our environment because of its similarity to the bile duct cyst. This study, which is a very illustrative case, showed us a diagnostic discrepancy between the result of cross-sectional imaging and that of surgery and pathology.