The diagnosis of abdominal cysts in infants and children.

Abstract

Intra-abdominal cystic masses in infants and children are of many different origins, requiring treatment by methods which are more or less unique depending upon the morphological type, anatomical location, and complications. Unfortunately, the clinical and radiological aids that may be used to determine these three important features are frequently omitted since, it is reasoned, an exploratory laparotomy is to be performed in any event. This approach is not to be condoned, for it has been shown, for certain cysts at least, that the operative mortality bears an inverse relation to the frequency of correct preoperative diagnoses (1). The surgical mortality rates are inordinately high in children with intra-abdominal cysts, and extensive preoperative investigative measures are justified if, by establishing the diagnosis, they tend to diminish the operative risk. Furthermore, one must know the type of cyst before it can be determined whether surgery should be performed immediately or should be postponed. With some cysts, the patient should receive chemotherapy before definitive measures such as aspiration or marsupialization are instituted. Even though operation is to be employed immediately, a precise preoperative diagnosis is of benefit, since it indicates the correct approach, may shorten the operative time, and may obviate the shock incident to extensive exploration during laporatomy to establish the diagnosis. The discussion to follow is concerned with the salient features of the different abdominal cysts that occur in children and infants and the findings, both clinical and radiological, that permit a differential diagnosis. Particular emphasis will be given to the radiographic methods that may be employed and to the radiologic criteria that aid in establishing a diagnosis, but a close correlation with the clinical and laboratory findings has been maintained. These data, supported by objective radiographic information, permit the formulation of an accurate and complete diagnosis. In general, cystic and solid masses may be distinguished by physical and roentgenologic examination. Cystic masses are characteristically soft, yielding, and fluctuant, and may rapidly change in size as the fluid content varies. A fluid wave may be elicited and, if air or gas is present within the cyst, a succussion splash can be heard. Occasionally the turgidity of the cyst contents or surrounding inflammation causes the mass to feel deceptively solid. Needle aspiration, however, will reveal its true character, and gross, microscopic, and chemical examinations of aspirated fluid frequently indicate the nature of the cyst. After the withdrawal of fluid, the injection of air or other contrast media into the cystic cavity will permit its delineation, and the accurate anatomical relations can be determined by radiographic studies. Even without the use of contrast media, cystic structures have certain roentgenographic characteristics which permit their recognition.