Abstract
Mesenteric cysts are rare intra-abdominal masses that usually remain asymptomatic and present incidentally on radiological imaging. As the incidence is low, with paucity of data, careful pre-operative assessment and execution of surgical procedure often present a challenge to the treating clinician. A 7-year-old female child presented with gradual distention of abdomen and dull abdominal ache. On clinical examination, a huge mass measuring 1812 cm was detected in the lower abdomen. On radiological imaging, a diagnosis of mesenteric cyst was made. Intra-operative findings were consistent with mesenteric cyst, and complete surgical excision was carried out by laparotomy. The histopathology report revealed a chylo-lymphatic type of mesenteric cyst. Huge, benign abdominal masses in pediatric patient may represent mesenteric cysts, and the diagnosis can be confirmed by radiological imaging modalities such as abdominal contrast-enhanced computed tomography. Complete surgical removal of the cyst remains the treatment of choice, as the literature is against marsupialization or aspiration of cyst owing to a higher chance of infection and morbidity.
Highlights
Mesenteric cysts are rare benign pathologic entities with an incidence of 1:100,000 in adults and 1:20,000 in pediatric hospital admissions (1)
We present a case of a large chylolymphatic cyst in a pediatric patient that was managed by en bloc surgical excision
The most accepted theory in formation of mesenteric cyst suggests its origin from abnormal proliferation of lymphatic tissue that fails to communicate to either lymphatic or venous system and develops into retention cyst (5)
Summary
Mesenteric cysts are rare benign pathologic entities with an incidence of 1:100,000 in adults and 1:20,000 in pediatric hospital admissions (1). Mesenteric cysts usually remain asymptomatic but may present as an incidentaloma or with abdominal distention, pain, or obstruction of bowel. A well-defined, non-tender, non-mobile lump was found occupying almost all of the middle and lower quadrants of the abdomen with a size of 18x12cm. Contrast-enhanced computed tomography scan of the abdomen showed a huge cystic mass, with a size of 17.5x11x9 cm and approximate volume of 1500 mL, extending from the greater curvature of the stomach to the pelvis, displacing the bowel loops laterally. The cyst was found to be filled with a sticky, brownish-yellow chylous fluid with approximate volume of 1.2 L. It was carefully dissected and excised en-bloc (Figure 3A–C).
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