Mesenteric and Omental Lymphatic Cysts in Children: A 23-Year Retrospective Descriptive Study from Central India

Abstract

Introduction: Lymphatic cystic malformations occur in the mesentery of the small and large bowel, omentum and retroperitoneal area and are rare, benign, intra-abdominal cystic lesions. Aim: To review the demographics, clinical presentation and surgical outcomes of children’s mesenteric and omental lymphatic cystic lesions. Materials and Methods: A single-institution, retrospective descriptive study was conducted in the Department of Paediatric Surgery, Gandhi Medical College and Associated Hospitals, Bhopal, India, from January 1, 2000, to December 31, 2023. It included cases of lymphatic cystic lesions in infants and children below 12 years of age involving the mesentery of the small and large bowel and omentum. The details collected from the case records were the age, sex, clinical presentation, radiological investigations carried out, operative findings and the outcome of the operative intervention executed for mesenteric and omental lymphatic cysts in children. The results obtained from the present study are expressed in numbers and percentages. Results: The present study analysed 18 children aged ≤12 years who underwent surgery for lymphatic cysts of the mesentery of the small bowel (n=14), large bowel/mesocolon (n=1) and omentum (n=3) during the study period. There were 11 boys and 7 girls. More than four-fifths (n=15) of the children were ≤5 years old at the time of diagnosis and operative therapy provided. One-third (n=7) of the cases clinically presented with the clinical features of intestinal obstruction. The cysts involved the mesentery of the small bowel in three-fourths (n=14) of the cases. The complete excision of the lymphatic cysts was possible in three-fourths (n=14) of the cases. In 10 children, resection of the adjacent/involved small bowel segment was also required during the operative procedures. Fifty percentage of the cases revealed volvulus of the small bowel caused by mesenteric cysts involving the small bowel. More than half of the cases required resection of the adjacent/involved segment of the small bowel along with excision of the mesenteric cysts. Conclusion: Mesenteric cysts are rare abdominal pathology with diverse clinical presentations ranging from vague abdominal pain and lump to an acute abdomen. Early referral to higher centres, diagnosis and prompt surgical excision of the mesenteric cysts can prevent volvulus, one of the most common complications and requirements of an emergency surgical procedure.