Bowel Obstruction Caused by Primitive Fibromuscular Hyperplasia of the Seminal Vesicle in the Elderly

A 79-year-old man with a 1-day history of increasing abdominal pain, decreased bowel activity, and abdominal distension was evaluated in emergency. Transabdominal pelvic ultrasonography and computerized tomography scans of the abdomen and pelvis showed the presence of a large pelvic multiloculated cystic mass between the bladder and rectum. At laparotomy, an extraperitoneal cystic lesion that was 20 cm in diameter was found to be compressing the bladder anteriorly and the rectum posteriorly. Definitive pathological diagnosis was fibromuscular hyperplasia of the seminal vesicle. The etiology of the cyst was most likely congenital, because a postoperative vesiculo-deferentography excluded the diagnosis of seminal stones. Prostatic disease was also excluded by a transrectal ultrasonograph. The patient's recovery was uneventful, and he was discharged on the seventh postoperative day. This is the first bowel obstruction caused by a congenital seminal vesicle cyst in the elderly reported in the literature.