Intra-abdominal Cystic Lesions Research Articles

Rare presentation of Omental Cyst in Inguinal Hernia

Introduction: Inguinal hernia is one of the most frequent surgery performed by pediatric surgeons and majority of the hernias are indirect inguinal hernia. Mostly the sac is empty or might contain omentun , small bowel , ovaries , fallopian tubes etc. Rarely we see patients in which sac contains huge cystic lesion. We present a case report of patient who presented to us with swelling in left inguinal region and a preiminalry diagnosis of Left inguinal hernia was made later on it was found that the hernia sac contains a huge omental cyst which remained un-diagnosed till the time of surgey. Omental cyst is one of the rarest types of intraabdominal cystic lesions in pediatric age group.

Cystica indeterminata – A novel intriguing pelvic pathology in a 9-year-old girl

Abstract Intra-abdominal cystic lesions are commonly associated with visceral locations such as renal, hepatic, pancreatic, ovarian/adnexal, and mesenteric. Rarely, nonvisceral locations such as retroperitoneum, free intra-peritoneum, prevertebral space, and pelvis harbor cystic lesions. In almost all these lesions, radiology, histopathology, immunostaining, and serology markers are able to assign a definite origin and pathogenesis. Very rarely a clear diagnosis is not possible, and these lesions have been designated as “indeterminate” lesions. We report the first case of “cystica indeterminata” with completely obscure origin and histopathogenesis in a 9-year-old female child. Clinical, radiological, seromarkers, histopathology, related differentials, and pathogenesis have been discussed. We hypothesize that aborted organogenesis or acquired degenerative/involutory changes may lead to such indeterminate lesions.

Intra-Abdominal Cysts Not Originating from Liver, Spleen, or Kidney in Children: Assessment of the Diagnostic Value of Ultrasound Features

Background: Cystic abdominal masses are relatively prevalent in the pediatric population. Ultrasound (US) often serves as the initial imaging modality for evaluating these lesions, assisting in diagnosis, and guiding clinical decisions. Objectives: This study aimed to delineate the characteristic US features of intra-abdominal cystic lesions not arising from the liver, spleen, or kidney in children and to assess their diagnostic value for providing definitive diagnoses. Methods: Conducted in the radiology department of pediatric hospitals affiliated with Mashhad University of Medical Sciences from 2019 to 2022, this cross-sectional study examined 104 children with cystic abdominal lesions. Patient demographic data and US characteristics were documented. Definitive diagnoses were established through histopathological reports, surgical outcomes, or clinical follow-up. The accuracy of US findings was evaluated against these definitive diagnoses, with the sensitivity and specificity of US features for various intra-abdominal cystic lesions being calculated. Results: The most frequent cystic lesions identified were perinatal ovarian torsion (22.1%) and duplication cysts (18.2%). Ultrasound achieved a sensitivity and specificity of 82.61% (95% CI = 0.6 - 0.94) and 100% (95% CI = 0.94 - 1), respectively, in diagnosing perinatal ovarian torsion and 89.47% (95% CI = 0.65 - 0.98) and 94.11% (95% CI = 0.86 - 0.97) in diagnosing duplication cysts. In 80.8% of the cases, the initial US diagnosis corresponded with the final diagnosis. Conclusions: Ultrasound exhibits commendable sensitivity and specificity in identifying intra-abdominal cysts not originating from the liver, spleen, or kidneys in children, demonstrating its effectiveness in the diagnostic evaluation of these lesions.

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

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.

Prenatal Diagnosis of Fetal Ovarian Cyst. Report of a Case

Background: Prenatal diagnosis of abdominal cysts is relatively common; The ovarian cyst is the most predominant chemical lesion of abdominal masses in female fetuses; however, given the wide variety of intra-abdominal masses, determining the origin of the chemical lesion is the most frequent diagnostic challenge, especially to establish fetal prognosis. Clinical Case: 30-year-old patient, who went to the emergency department for uterine contractions, no prenatal control, during the ultrasound evaluation, polyhydramnios and an intra-abdominal cystic lesion measuring 4.9 x 3.9 cm, without septa and with a thin wall were documented, the area was intentionally reviewed. renal, hepatic, and intestinal; Without involvement of these structures, female genitalia were confirmed, concluding in a probable ovariandependent cyst, admission for resolution of the pregnancy via the abdomen due to pelvic presentation and labor, at birth the diagnosis was confirmed. Conclusions: Timely detection of an intra-abdominal chemical injury and ecological follow-up improve perinatal prognosis.

Intra-abdominal cystic lesions after ventriculoperitoneal shunting

Objectives: Definitive diagnosis is essential for the medical and surgical management of pediatric patients with ventriculoperitoneal (VP) shunt. In patients with a VP shunt, abdominal complications have been well described, among which abdominal pseudo cysts are uncommon. In this report, we present our experience in terms of the multi-disciplinary management of intra-abdominal cystic lesions associated with the VP shunt procedure. Methods: From 2016 to 2021, 245 VP shunt procedures were performed in our institution. Intra-abdominal cystic lesions were recorded as intra-abdominal complications (abdominal pseudocyst, intestinal subserosal bowel cyst, and scrotal cyst) in 3 patients. For these patients we retrospectively collected data on medical history, complaints, diagnosis, treatment procedure, and postoperative results. The study was performed on 2 male and 1 female patients. The average patient age was 11.6 months (5 months to 1.5 years). The most common complaint was that of abdominal distention with ileus symptoms. The average time of admission after the catheterization of VP shunt was 1 month; laparotomy was performed for 2 patients in whom treatment was needed for high ligation. Results: A VP shunt operation is followed by abdominal complications in about 5%-47% of all cases. These complications are manifested as ileus symptoms, such as vomiting, abdominal distension, and abdominal pain with intestinal obstruction. Conclusions: In pediatric patients with VP shunts, a shunt catheter-induced abdominal cystic formation should always be considered a complication. Management of these cystic lesions requires the use of a multi-disciplinary approach with neurosurgery and pediatric surgery for treatment.

Predictive value of prenatal ultrasound in foetal intraabdominal cystic lesions and evaluation of perinatal outcomes: a single-centre study results

The prenatal diagnosis of intra-abdominal cystic lesions is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound in identifying the aetiology of foetal intra-abdominal cysts and to describe the prenatal and postnatal outcomes. This study is a retrospective analysis of 137 foetuses diagnosed with intraabdominal cysts during the prenatal period, except those originating from the urinary system, conducted from April 2015 to August 2018. Among 137 intraabdominal cysts identified as antenatal, ovarian cysts had the highest rate of prenatal diagnosis. The most frequently misdiagnosed pathologies were gastrointestinal system obstructions with 6 cases. There were 129 (94.2%)cases of intraabdominal cysts born alive. Intrabdominal cystic lesions resolved spontaneously in 23(16.8%) cases in the intrauterine period and 28 cases within 12 (20.4%) months after birth during follow-up. Postpartum surgical treatment was performed in 44 (%32.1) cases. The overall neonatal mortality was 21/137 (15.3%),with no death in the intrauterine period; 8(5.8%) of these were death following termination of pregnancy, 6(4.4%) were postpartum, and 7(5.1%) were post-surgical death. Postnatal results of intraabdominal cysts are variable. Therefore, individual assessing and managing each case is of clear benefit due to cyst’s variable course. IMPACT STATEMENT What is already known on this subject? The prenatal diagnosis of intra- abdominal cystic lesions is relatively common and prenatal ultrasound is the main screening tool. The diagnosis of a foetal intra-abdominal cyst might represent a diagnostic and management dilemma due to the wide variety of potential diagnosis. What the results of this study add? The accuracy of prenatal ultrasound in identifying the origin of a foetal intra-abdominal cyst seems to be high with detailed ultrasonographic examinations and the perinatal outcome of these foetuses is favourable in most of them. What the implications are of these findings for clinical practice and/or future research? Regardless of the cyst’s origin, it should be kept in mind that prenatal and postnatal clinical courses can be variable in each case, and every pregnant woman with a foetus with an intraabdominal cyst must be managed individually in every aspect.

The Role of Surgery in Antenatal Ovarian Torsion: Retrospective Evaluation of 28 Cases and Review of the Literature.

Antenatal ovarian torsion (AOT) is rare and requires differentiating from other congenital cystic masses of the abdomen and pelvis in neonates. In this study, it was aimed to evaluate the prenatal characteristics and postnatal outcomes of AOT. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Hospital records of patients (n=28) with diagnosis of AOT between 2004 and 2020 were reviewed and their prenatal characteristics, postnatal examination, imaging, operative, and histopathological findings were evaluated. There were 28 patients during the study period. In most of the patients (25/28; 89.3%) AOTs were detected prenatally. All were term babies with a mean birth weight of 3010 ± 466.6 g. Mean maternal age was 25.75 ± 3.65 years. Prenatal history was event-free in all and none had additional anomalies. Physical examination revealed mobile intra-abdominal cystic lesions in 16 (57.1%) patients. AOTs mimicked other pathologies as intestinal duplication cyst or mesenteric cyst (n=7), complex ovarian cyst (n=3), mature cystic teratoma (n=3), simple renal cyst (n=1), and ectopic kidney (n=1) in 15 (53.6%) patients in postnatal ultrasonography. Elective laparoscopic surgery was performed in 26 (92.8%) patients. The other 2 patients required emergency open surgery because of acute symptoms. Ovaries were autoamputated in 17 (60.7%) patients. Histopathological examination revealed necrosis and dystrophic calcification in all specimens. There was neoplastic involvement in 2 patients (serous cystadenoma and gonadoblastoma). No complication occurred in the early follow-up period (mean: 73.9 ± 46.8 months). AOTs can be detected easily during the antenatal period. Neoplastic involvement with AOTs is rare but possible. Although AOTs might mimic other cystic pathologies, it should be one of the first diagnoses to be considered, in the presence of a palpable intra-abdominal mass and complex cystic lesion in infant girls. It can be efficiently and safely managed using minimally invasive techniques.

The Role of Tissue Harmonic Ultrasonography and Computerized Tomography in the Diagnosis of Intraabdominal Cystic Lesions

Aim: Abdominal Ultrasonography (US) and Computed Tomography (CT) examinations are imaging methods frequently used in Radiology Clinics. During these examinations, cystic lesions are frequently detected in the abdomen. It is an important problem to identify and characterize the clinical significance of these cysts.Methods: The findings of 145 patients who underwent abdominal imaging in the US and CT units of the Istanbul Training and Research Hospital Radiology Clinic and were found to have cystic lesions were analyzed retrospectively. The CT findings of cystic lesions detected in the abdominal organs or the abdominal cavity were reviewed, and the contribution of the new US image acquisition method, Tissue Harmonic Imaging (THI), to the characterization of cysts was examined.Results: A total of 145 patients, 56 men (39.3%) and 89 women (60.7%) with cystic lesions in the abdomen, were included. We detected cystic lesions most frequently in the kidneys (n:68, 46.89%) and second most frequently in the liver (n:65; 44.82%). In addition, we detected cystic lesions in the spleen in 5 cases (3.44%), in the pancreas in 7 cases (4.82%), and in the abdominal cavity in 5 cases (3.44%). In all our cases, cystic lesions could be visualized in both THI imaging and CT examination.Conclusion: THI examination provides valuable information in characterizing cystic lesions, especially by showing the wall feature of the cyst, the internal septa and the presence of intra-cystic solid component, while CT examination especially shows the wall calcification and the presence of air in the abscess, as well as the intramural solid component.

Antenatal Ovarian Torsion Presenting With Features of Intestinal Obstruction in a Neonate

With the advent of antenatal ultrasonography (USG), detection of neonatal intra-abdominal cystic lesions is on the rise. We present a neonate who was detected antenatally to have a cystic lesion per abdomen and presented with features of intestinal obstruction on first postnatal day. Emergency exploratory laparotomy revealed a left torsed ovarian cyst compressing the ileoceacal junction. Left oophorectomy was done and ovarian torsion was confirmed by histopathology examination. The USG abdomen at six months follow up showed a well visualised right ovary.

Cystic Gastrointestinal Tumors: An Unusual Imaging Appearance − A Case Series

Gastrointestinal stromal tumors (GISTs) are commonly seen mesenchymal tumors of stomach and digestive tract. Morphologically they show similarities to other tumor types and were previously misclassified as leiomyomas, leiomyoblastomas, or leiomyosarcomas. GISTs are typically solid tumors with larger tumors showing areas of necrosis and rarely present with predominantly cystic changes. Here we report three cases of GISTs with predominant cystic component. Cystic GISTs although rare, should be considered as part of differential diagnosis for large intra-abdominal cystic lesions. Immunohistochemistry is critical for final diagnosis.

An Unusual Case of Mucinous Cystic Neoplasms of the Pancreas at Pregnancy

A mucinous cystic neoplasm (MCNs) of the pancreas is an uncommon tumor that occurs mostly in females and are potentially sex hormone-sensitive. However, a MCN occurring during pregnancy is quite rare. A 25-year-old woman in the 35 week of gestation was referred to us because of a left flank pain. After unsuccessful treatment for pyelonephritis, a MRI revealed a large intra-abdominal cystic lesion. The patient subsequently underwent cesarean delivery and latter had tumor resection with distal pancreatectomy and splenectomy. Histopathological revealed a pancreatic MCN with low grade dysplasia. Our case strongly indicates the importance of further evaluation for uncommon causes for left flank pain.

An Interesting Case of a Large Cystic Mesothelioma of the Omentum in a Pediatric Patient

AbstractWe present an interesting case of a large intra-abdominal cystic lesion in a 14-year-old girl who presented with abdominal discomfort and pain. The patient was evaluated with magnetic resonance imaging (MRI) and found to have a large septated cystic lesion arising from the gastrohepatic omentum. She underwent surgery, and the diagnosis of cystic mesothelioma was confirmed in the histopathology. To the best of our knowledge, only a few cases of benign omental mesothelial cysts have been reported.

Prenatal diagnosis and prognosis assessment of fetal intra-abdominal cystic lesions: a retrospective study in 264 cases

To assess the accuracy of prenatal diagnosis and the prognosis of fetal-abdominal masses, we reviewed all of the cases which had been diagnosed as having abdominal masses from January 2014 to December 2016. In total, 264 cases were identified as having abdominal masses. Among them, 141 cases (53%) had received specific prenatal diagnoses by prenatal ultrasound (US). MRI had assisted in the diagnosis and prognostic evaluation in 69 cases, increasing the diagnostic rate to 65%. The prenatal diagnoses of 111 cases (65%) were concordant with the postnatal diagnoses. Surgical intervention after birth was needed in 96 cases (39%). Most outcomes were good (89%). We suggest that prenatal US can detect and identify most fetal abdominal masses and that MRI helps to further describe the masses. With early intervention after birth, the prognosis was good in most cases.Impact StatementWhat is already known on this subject? Fetal-abdominal masses are commonly detected in antenatal examinations. A prenatal ultrasound is the main screening tool for detecting fetal intra-abdominal cystic lesions.What the results of this study add? We suggest that MRI is more helpful in some systems to reveal locations and structures. Even prenatal diagnosis cannot reach before birth, prognosis is quite good and expectant therapy is sufficient.What the implications are of these findings for clinical practice and/or future research? Our data strengthens the current knowledge of fetal abdominal masses to help relieve anxious parents by telling them that this congenital malformation has good outcomes. But multidiscipline consultation is necessary.

Intraductal papillary mucinous neoplasm developed on an ectopic gastric pancreas

In January 2014, a 69-year-old man with end-stage renal disease requiring dialysis was evaluated for kidney transplantation. During the work-up, abdominal ultrasound found an ill-defined intraabdominal cystic lesion. Abdominal magnetic resonance imaging revealed a 60 × 50 mm multiloculated cystic lesion developed over the lesser gastric curvature (Fig. 1). An endoscopic ultrasound (EUS) confirmed a subepithelial 60-mm a cystic gastric tumour. Fine needle aspiration was negative for malignancy. In order to rule out a primary gastric tumor, surgery was scheduled. A partial gastrectomy was performed with an uneventful postoperative course. Gross pathology found a 60-mm cystic tumor located into the gastric wall. Histology found heterotopic pancreatic tissue composed by ducts and acini (Fig. 2) into the gastric wall. Epithelial cells were mucin-secreting and columnar with extensive intestinal metaplasia and low degrees of atypia. Mucinous deposits were present over the lesser omentum. The diagnosis of intraductal papillary mucinous neoplasm (IPMN) with low grade dysplasia developed on heterotopic gastric pancreatic tissue was established. Six years later the patient was doing well under dialysis. The prevalence of heterotopic pancreatic tissues ranges from 0, 6 to15% and IPMN development has been rarely reported as a possible complication of a heterotopic pancreas [ [1] Patel N. Berzin T. Intraductal papillary mucinous neoplasm arising in a heterotopic pancreas: a case report. Am J Gastroenterol. 2010; 105: 2513-2514https://doi.org/10.1038/ajg.2010.298 Crossref Scopus (11) Google Scholar ]. Symptoms are unspecific and surgery should be advised based on the size and morphology of the lesion. Fig. 2Histological examination showing heterotopic pancreatic tissue into the gastric wall with acini and ducts. View Large Image Figure Viewer Download Hi-res image

A hydatic cyst of the appendix mimicking a uterine lateral mass: a case\xa0report

BackgroundHydatic cyst is a zoonotic disease caused by Echinococcus granulosus. It is a public health problem in Tunisia and remains endemic. It occurs in intra-abdominal organs in 10–15% of the cases, particularly in the liver representing the most common affected organ. The aim of the case is to highlight the scarcity of this appendicle origin and to consider it among the differential diagnosis of any intra-abdominal cystic lesion.Case presentationA 45-year-old Tunisian woman, with no past medical history, was admitted for a pelvic cystic mass. The clinical manifestation as well as the imaging findings were toward a lateral uterine mass. Our patient underwent appendectomy and resection of the mass. The patient had no recurrence at 2 years of follow-up.ConclusionsAn extrahepatic hydatid cyst should be recognized among the differential diagnosis of any intra-abdominal cystic lesion. Treatment should be based on surgical excision. Due to the risk of recurrence, a close follow-up is mandatory.

A Chylous Mesenteric Cyst Masquerading as a Pancreatic Mass

A 51 year-old male was referred for further evaluation of an incidental finding of a large cystic mass inferior to the uncinate process of the pancreas and anterior to the 3rd portion of the duodenum. The cystic mass was initially noted on a CT pyelogram ordered to evaluate microscopic hematuria. His past medical history was remarkable only for morbid obesity; he had no history of abdominal surgery or alcohol abuse. He reported feeling well and specifically denied fevers, chills, night sweats, weight loss, nausea, vomiting, abdominal pain, and diarrhea. A comprehensive metabolic panel and complete blood count were unremarkable. Further imaging with MRCP/MRI of the pancreas showed a T2 hyperintense, microlobulated, multiseptated, and multi-cystic mass measuring 6.0 x 5.1 x 3.6 cm overall with the largest cystic component measuring about 3 cm in size. The mass was centered at the third portion of the duodenum but also in close proximity to the tip of the uncinate process with lack of a fat plane between the uncinate process and the mass. It appeared to partially surround and cause mild narrowing of the third portion of the duodenum. There was no demonstrated communication between the mass and the pancreatic duct. The patient subsequently underwent endoscopic ultrasound (EUS) with fine-needle aspiration, during which 18 mL of milky-white fluid was aspirated from the largest cyst. Analysis revealed fluid CEA 27.3 ng/mL, amylase 47 U/L, and triglycerides 6162 mg/dL. Cytology showed scant lymphocytes and macrophages in a background of acellular debris with no malignant cells identified. This case exemplifies the rare but fascinating diagnosis of a chylous mesenteric cyst. A recent review found only 19 cases reported in the literature since 1980. This review noted an average age of 46, a slight male predominance (1.4:1), and many cases were discovered incidentally in asymptomatic patients. Surgical resection has been the mainstay of treatment, but there is no clear evidence of malignant potential and overall prognosis appears to be good. This case also demonstrates the utility of EUS as a minimally invasive diagnostic tool in the initial evaluation of intra-abdominal cystic lesions. Our patient remained asymptomatic following his diagnosis and we plan periodic surveillance with MRI given the limited information regarding the natural history of these lesions.

Atypical presentation of a gastric stromal tumor masquerading as a giant intraabdominal cyst: A case report.

Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms that arise in the gastrointestinal tract, accounting for ~1% of gastric malignancies. The present study reports the case of a GIST of the stomach in a 75-year-old man who presented with abdominal distension and anorexia for 1 month. Gastroscopy was unremarkable. Ultrasound and computed tomography (CT) scans showed a giant intraabdominal cystic lesion of unknown origin. The lesion was initially believed to be a duplication cyst, a pancreatic pseudocyst or a liver cyst in the pre-operative diagnosis. Exploratory laparotomy revealed a cystic lesion of the lesser sac originating from the lesser curvature of the stomach. A distal gastrectomy with en bloc resection of the lesion was performed. The intraoperative frozen section showed a spindle-cell GIST and microscopically negative margins. The patient was treated with imatinib for 1 year. The latest CT scan at 14 months post-surgery did not show any recurrence. Although GISTs presenting as predominantly cystic lesions are very rare, they should be considered in the differential diagnosis of cystic lesions of the upper abdomen.

Utility and safety of laparoscopy for intra-abdominal cysts in small children: Single center experience

Objectives: The objective of this study is to study the utility and safety of laparoscopy in the management of intra-abdominal cysts in small children. Materials and Methods: This is a retrospective analysis of patient data that underwent laparoscopy for intra-abdominal cystic lesions. The study period was from March 2010 to April 2015. Patients with adequate follow-up and complete data were included for study. The patients were divided into 3 age groups for analysis of the outcome viz. neonates, infants, and children between 1 and 5 years of age. The data were analyzed for spectrum of lesions managed, surgical procedure performed, operative time, intraoperative events, need for conversion, time to discharge, and the overall outcome. Results: A total of 106/121 patients with adequate follow-up are included for the study and most of the patients (63.6%) belonged to children between 1 to 5 years. Wide spectrums of lesions were managed laparoscopically, and majority 45 (42.4%) had cysts arising from the hepatobiliary system whereas genitourinary system lesions formed 2nd largest group with 21 (19.8%) patients. The procedure was completed laparoscopically in 86.6% (92) of the patients. The morbidity including wound infection, re-exploration, and recurrences, were seen in 5% of patients. The average duration of hospital stay was 4.6 days (range 2-21 days), and the average duration of follow-up was 96 months (range 6-180 months). Conclusion: Laparoscopic surgery is a fascinating technical development for pediatric surgeons. It is applicable for the wide variety of intra-abdominal cystic lesions in children. Excisional surgeries are best performed by laparoscopic technique even in small infants and neonates. In the hands of experienced surgeons, reconstructive surgeries have good outcome with minimal morbidity.

Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound

Objective: The finding of a fetal intra-abdominal cyst is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound (US) in identifying the etiology of fetal intra-abdominal cysts and to describe the neonatal outcomes.Methods: All cases of fetal intra-abdominal cystic lesion referred to our center between 2004 and 2012 were reviewed. Cysts of urinary system origin were excluded. Prenatal and postnatal data were collected. Our cohort was divided into subgroups according to the prenatal suspected origin of the lesion (ovarian, mesenteric, gastro-intestinal and other locations). For each subgroup, sensitivity, specificity, positive predictive value, false-positive rate and accuracy of fetal US were calculated.Results: In total 47 fetuses (10/37 M/F) were identified. The mean gestational age at the time of diagnosis was 33 ± 4.9 weeks. Our cohort comprised of 25 ovarian cysts (10 simplex and 15 complex), 3 GI duplication, 6 mesenteric lesions, 4 meconium pseudocyst and 9 lesions of other origin. Surgery was performed in 38 cases (81%) at birth. The prenatally established diagnosis was exactly concordant with post-natal findings in 34 cases (72.3%). Sensitivity, specificity, positive predictive value and false-positive rate of US were 88.1%, 95.5%, 71% and 5.4%, respectively. Long-term outcome was good in almost 90% of the cases.Conclusions: The etiology of fetal intra-abdominal cysts can be prenatally diagnosed in about 70% cases. Despite the high risk of surgery at birth, the long-term outcome was good in most of the cases.