Mesenteric Cyst Research Articles

Lymphatic malformation of abdomen in children; eight year experience from a tertiary care centre.

Introduction: Lymphatic malformations of abdomen include mesenteric, omental and retroperitoneal cysts. These are benign malformations with variable presentation. These malformations may present as abdominal distension, abdominal pain, features of intestinal obstruction and rarely acute abdomen. Ultrasonography, CT scan and MRI provide characteristics of malformations like size, composition and may at times help in determining the origin of the lesion. Surgical exploration confirms the diagnosis besides being therapeutic. The mesenteric and omental cysts are either enucleated or need bowel resection or sometimes, partial cyst excision with marsupliazation. Intraoperative injection of the sclerosing agent is an option in instances when excision is not possible or feasible. We analysed the clinical characteristics, management and follow-up of these cases in our study. Methods: We analysed 26 cases of abdominal lymphatic malformations. The data regarding epidemiological and clinical characteristics were reviewed and recorded. Operative record and imaging findings were noted. The long and short term results of the surgical treatment were analysed. Results: Twenty six cases (18 Male:8 Female) were included in this study. The most common presentation was chronic abdominal symptoms like pain, vomiting or distension. Three patients had antenatal diagnosis while eleven patients had symptoms three months before being diagnosed. The average age of presentation was 48.64 months. Twelve (46.15%) patients had solitary cyst. Fifteen (57.69%) patients had mesenteric cyst, 6(23.07%) had omental cyst and five (19.23%) patients had cyst extending to the retro peritoneum. Twelve patients underwent enucleation. Serous fluid was the content in ten (38.48%) patients. Two patients needed emergency surgery for intestinal obstruction. The average follow-up was 46 months. Two patients required re-exploration after initial incomplete resection. Overall recurrence rate was seen in four cases (15.38%). Conclusion: Lymphatic malformations of abdomen can have varied presentation. Ultrasonography and CT scan or MRI is useful diagnostic tools. Mesenteric cysts need resection anastomosis. Omental cysts are amenable to resection. Multi-loculated and retroperitoneal cyst may need partial excision or sclerotherapy. Long term outcome is excellent.

Mesothelial Cyst in a Young Female: Case report and literature review

Mesenteric cysts are rare intra-abdominal benign tumors (1 in 100,000 cases in adults) with various clinical presentations. [1,2] They commonly originate from the small bowel mesentery, although a proportion has been found to originate from the mesocolon, and retroperitoneum. [1,3] The formation of mesenteric cysts depends on the histologic origin, where they could be classified into cysts of lymphatic origin, cysts of mesothelial origin, cysts of enteric origin, cysts of urogenital origin, dermoid cysts and pseudocysts. [4,5] Diagnosis is extremely difficult since. The Mesenteric cyst is usually asymptomatic, but if symptomatic, abdominal pain (82%), nausea and vomiting (45%), constipation (27%) are the most common presenting symptoms. [2,3] The clinical finding of abdominal mass is encountered in more than 61% of the patients. [2,3]. As this condition is very rare and its symptomatology can resemble any other abdominal diseases, diagnosis is extremely difficult and incorrect preoperative diagnosis is often made. Hence, performing physical examination and conducting radiological investigations such as ultrasonography (USG) and computed tomography (CT) are important in making a correct diagnosis. [2,3] As well as cases of mesothelial cysts, they are typically asymptomatic but occasionally, their symptoms are vague and non-specific. [6,7] As mentioned above, imaging modalities such as USG, CT and magnetic resonance imaging (MRI) are great in identifying the character, size, location, surrounding tissues and the wall and content of the cysts. [7] Surgery is the treatment of choice, as a complete resection with negative borders is curative and often prevents recurrence. [3] We report a case of a young female patient who presented with a vague abdominal symptoms and a large cystic mass in lower abdomen. After proper evaluation, surgical exploration revealed a large simple mesothelial cyst.

Concurrent occurrence of primary mesenteric hydatid cyst with multiple calcified splenic granulomas: A rare presentation

Concurrent occurrence of primary mesenteric hydatid cyst with multiple calcified splenic granulomas: A rare presentation

Case of Mesenteric Cyst in Which Resection Was Performed Under Suspicion of an Infection

Case of Mesenteric Cyst in Which Resection Was Performed Under Suspicion of an Infection

Bleed into an undiagnosed mesenteric cyst following mesh repair for incisional hernia: A surgical nightmare

Bleed into an undiagnosed mesenteric cyst following mesh repair for incisional hernia: A surgical nightmare

Abdominal cystic lymphangioma mimicking ovarian mass: A case report and literature review.

Cystic lymphangiomas are uncommon benign lesions extremely rare in the adult population. Most cases are found in the neck and axillary regions; while <1% of patients present with cystic lymphangiomas in the mesentery, greater omentum and retroperitoneum. The present report describes a rare case of large omental lymphangioma mimicking ovarian mass. A 40-year-old G2P2 female patient presented without symptoms for routine gynecological examination. Transvaginal ultrasound examination revealed a cystic mass with a maximum diameter of 10 cm localized at the right parametrium space, suggestive of large cystic lesion of the right ovary. Further preoperative evaluation by magnetic resonance imaging indicated that the mass was either cystic lymphangioma or mesenteric cyst. Complete excision of the cyst without need for gastrectomy was performed via laparotomy under general anaesthesia. Histology revealed omental lymphangioma. Most abdominal lymphangiomas are initially asymptomatic. The role of synchronous imaging examinations, such as ultrasonography and magnetic resonance imaging, in diagnosis of these lesions is crucial. Full preoperative differential diagnosis evaluation in cases of large intraabdominal lesions is required in order to decide the appropriate surgical approach and management.

Amyand\u2019s hernia associated with mesenteric chylous cyst in infant: a rare case report

BackgroundAmyand’s hernia is a rare condition approximately 0.4–0.6% of all inguinal hernias. Although rare, the Amyand’s hernia is worthy of discussion since the variable presentation that make clinical challenge to diagnose especially in infant. A mesenteric chylous cyst is rare disease and has not been reported in Amyand’s hernia.Case presentationWe report an unusual case of Type II Amyand’s hernia with an enlarging chylous mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. A-2-months old infant presented with enlarging mass in the right scrotal. During laparotomy exploration, we found inguinal sac with intestinal and appendix content in the sac. In the edge site of the sac we found enlarging of mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. Based on the histopathology examination, the morphological feature is suitable for mesenteric chylous cyst appearance.ConclusionPresentation of mesenteric chylous cyst is rare, and there was no report about it in Amyand’s hernia. This unusual presentation should be considered by the surgeon, especially pediatric surgeon, in Amyand’s hernia cases.

Leiomyosarcoma of ileal mesentery in a middle age female: a rare case report

BackgroundLeiomyosarcoma arising from mesentery is a rare tumor associated with worse prognosis. The tumor arises from smooth muscles in vascular wall. Ileal mesentery is common site of this tumor origin.Case presentationA middle age female was presented with complain of abdominal distension. A mass was palpable on abdominal examination. CT scan showed large mesenteric cyst. 15 × 10 cm large mass excised with associated mesentery and small bowel segment and on histopathology was found, and it was diagnosed as mesenteric leiomyosarcoma. The patient was discharged and referred to oncology for chemotherapy.ConclusionLeiomyosarcoma is a rare disease with grave prognosis. There is a paucity of literature and proper guidelines for its management; however, surgical excision with healthy margins is a mainstay of management. Close follow-up is recommended post-operatively because there are high chances of recurrence and metastasis.

Late Presentation of Pancreatic Pseudocyst in a Child

Late Presentation of Pancreatic Pseudocyst in a Child

Mesenteric Cysts: A Retrospective Review. Its Not All That Simple

Abstract Introduction/Objective Mesenteric cysts are rare intra-abdominal lesions in adults. However, with the advanced imaging techniques and laparoscopic techniques, they are more often being identified and resected when clinically significant. There is a lack of detailed information in histopathology (except as case reports) since mesentery is generally neglected in our organ-based textbooks. The aim of our study is to highlight the importance of identifying and classifying mesenteric cystic lesions; they are not all that simple. Methods We performed a retrospective search on all mesenteric cysts submitted as excisions in our electronic database from 2013-2019. We classified them as per the de Perrot (PMID: 11053936) classification with modification. Results Our search showed: A. Lymphatic origin-11 (lymphangioma-10, Lymphangioma hamartomatous-1, associated with LAM-0), B. Mesothelial origin-68 (Benign mesothelial cysts-57, multilocular mesothelial cyst-11), C. Enteric origin- 3, D. Urogenital origin (Urachal cyst, mullerian inclusion cyst)-9, E. Mature cystic teratom-2, F. Pseudocyst-12, G. Epithelial cyst (not urogenital)- 11 (a/w LAMN-3, MCN-4, Mucinous cystadenoma-4), H. Associated with carcinoma-2. Case illustration: A 61-year-old male presented with worsening dysphagia, emesis and hiccups. A CT scan showed a 21.2 cm cystic mass with at least one septation (Fig 1). The cyst was resected. On gross pathological examination, the cyst measured 18 cm in greatest dimension with a thick, rough, tan-brown capsule. Microscopic examination showed a fibrous capsule, and cyst wall composed of numerous lymphatic vessels (CD31 positive) and prominent smooth muscle proliferation (Desmin positive). Scattered lymphoid aggregates were also present throughout the cyst wall. No definite epithelial lining was identified and was suspected to have been denuded. HMB-45 immunostain was negative, ruling out association with LAM. The final diagnosis of a Lymphangiomyoma, hamartomatous was rendered. Conclusion Though most of the mesenteric cysts are benign, some of them are significantly important such as Lymphangiomyoma (esp secondary to LAM), MCN, those associated with LAMN etc. and identifying and differentiating from their mimics has distinct clinical implications.

Management of Mesenteric Cysts in Pediatric Population: Five-year Experience in Tertiary Care Center

Introduction To study the clinical features, diagnosis and treatment of mesenteric cysts in pediatric age group (&lt; 15 years). Materials and Methods This was a retrospective analysis which inculded 35 children diagnosed and treated for mesenteric cysts in the pediatric surgery department from January 2014 to January 2019. Patient's data were retrieved from case sheets and analyzed. Patients with atleast one year follow-up were included in the study. Results Thirty-five patients were included in the study. Twenty-one (60%) were males and fourteen (40%) were females. Mean age of presentation and surgery was 24 months. Twenty-six (74.2%) patients were managed by bowel resection, while 9 (25.7%) were managed by simple cystectomy. The average size of the cyst was 15 cm (ranging from 5 to 25 cm). Content of cysts was mostly chylous (82.9% cases). No recurrence was found throughout the follow-up period (1–2 years). Conclusion Mesenteric cyst should be considered as a differential diagnosis in pediatric patients with acute or subacute intestinal obstruction and with or without a palpable lump in the abdomen. Mesenteric cysts can be managed surgically with favorable outcomes.

Giant mesenteric cysts diagnosis and treatment.

Giant mesenteric cysts diagnosis and treatment.

Mesenteric cyst: A rare incidental finding or a cause of gastrointestinal symptoms?

Mesenteric cyst: A rare incidental finding or a cause of gastrointestinal symptoms?

S1550 Abdominal Cysts: To Drain or Not to Drain, a Rare Case of a Mesenteric Cyst

INTRODUCTION: Mesenteric cysts are rare benign intra-abdominal tumors with an incidence of approximately 1 case per 100,000–250,000 hospital admissions. This was first described in 1507 by Italian anatomist Benevenni while performing an autopsy. Unfortunately, exact etiology is still unknown, but the most accepted theory is thought to be a benign proliferation of ectopic lymphatics in the mesentery. This benign lesion has a low incidence rate, as they are considered the rarest variety between abdominal cysts. CASE DESCRIPTION/METHODS: This is a 35-year-old African American female with a past medical history of chronic cholelithiasis presented to the hospital with complaints of worsening right upper quadrant (RUQ) abdominal pain and nausea for a few months. Patient had no weight loss, or loss of appetite, and no history of alcoholism or pancreatitis. Patient was vitally stable. Exam showed mild RUQ tenderness, and a negative murphy’s sign. Labs revealed mild transaminitis with a normal serum lipase. Computerized tomography (CT) was performed, showing a large cystic mass in the RUQ measuring 10.3 × 9.8 × 11.3 cm exerting mass effect on the pancreas and gallbladder with mild intrahepatic biliary ductal dilatation. Endoscopic ultrasonography (EUS) was done for possible drainage via axios stent, but a septated cystic structure was seen. Given no history of pancreatitis and the complexity of the cyst, fine needle aspiration was performed instead, showing a bile-like fluid aspirate suggesting a possible biloma. Fluid analysis was negative for bilirubin, carcinoembryonic antigen and lipase. Patient then underwent an exploratory laparotomy which revealed a mass adherent to the gallbladder, but intra-operative cholangiogram was negative for any communication. Cholecystectomy and cyst removal were performed, and pathology was consistent with a mesenteric cyst. DISCUSSION: Mesenteric cysts are defined as any cyst in the mesentery of the gastrointestinal tract that may extend into the retroperitoneum. They can present at any age but are most seen in the second decade of life. Most are identified as painless, mobile, periumbilical masses, and treatment is usually surgical resection without drainage, if symptomatic. We present a case of an abnormally located mesenteric cyst, mimicking biliary/pancreatic pathology, and although low on the differential, one must look at the patient’s history and not assume all abdominal cysts are common and drainable, as not all abdominal cysts are created equally.Figure 1.: Computerized tomography showing a 10.3 × 9.8 × 11.3 cm cystic structure.Figure 2.: Endoscopic Ultrasonography showing a septated cystic structure.Figure 3.: Intraoperative Cholangiogram.

S3544 What's That Cyst?

INTRODUCTION: Pancreatic cysts are rare in children and consist of six classifications: congenital, retention, duplication, pseudocyst, neoplastic, or parasitic. Most pancreatic cysts are asymptomatic but can be symptomatic if causing mass effect on adjacent structures. This is a case of a pediatric pancreatic cyst. CASE DESCRIPTION/METHODS: An 11-year-old Caucasian Female presented for progressive acute on chronic abdominal pain with associated nausea, vomiting, and weight loss for 2 to 3 years. The patient had no previous medical, surgical, or travel history. Right upper quadrant abdominal ultrasound demonstrated a complex cystic mass measuring 7.41 × 7.11 × 7.17 cm with a focal solid area representing hemorrhage, concerning for a complex mesenteric cyst or duplication cyst. Given this finding, the patient underwent a computed tomography scan of the abdomen and pelvis that re-demonstrated the same thick-walled mass, abutting the anterior medial aspect of the second portion of the duodenum, concerning again for a duplication cyst. Of note, there was no biliary ductal dilatation or pancreatic ductal dilation. Comprehensive metabolic panel was significant for only mild elevation of total bilirubin to 0.8 mg/dl. Magnetic resonance imaging of the abdomen again showed a large cystic mass with a diameter of 6.3 cm, contiguous with the pancreatic head and neck with local mass effect on the duodenum, and a moderately thick wall and internal debris. Endoscopic ultrasound demonstrated a septate cystic mass with internal debris measuring 7.2 × 6.0 cm. Given these findings, the decision was made to forego fine needle aspiration of the sterile mass. The patient ultimately underwent a pancreaticoduodenectomy. Final pathology demonstrated a benign pancreatic cyst or congenital pancreatic cyst with no definite epithelial lining. Lymph nodes were negative for malignancy. DISCUSSION: This case highlights a pancreatic cyst that was discovered due to obstructive symptoms. The patient underwent a noninvasive multi-modal imaging technique consisting of ultrasound, CT scan, and MRI leading to endoscopy and eventually surgery to delineate the final pathology of the cyst. Unlike most congenital pancreatic cysts which originate at the pancreatic neck or tail, our patient had a cyst in the pancreatic head with close proximity to the duodenum. As demonstrated in this patient, pancreatic cysts are rare in children and involve a multi-disciplinary approach for appropriate evaluation and management.

Recurrent Mesenteric Cyst in an ESRD Patient on Maintenance Hemodialysis

Recurrent Mesenteric Cyst in an ESRD Patient on Maintenance Hemodialysis

Mesenteric Cyst in 22 Cases.

The aim of this study is to retrospectively and multi-centerly examine the clinicopathological features of patients who were operated with the diagnosis of mesenteric cyst, which is a rare cause of intra-abdominal mass in the last 9 years, in the light of the literature. The patients were operated due to mesenteric cysts in the general surgery clinics of two Training and Research Hospital between 2010 and 2019; age, gender, preoperative clinical findings, computed tomography (CT) findings, localization of the mass, surgical procedure, morbidity, histopathological results, and follow-up period status were analyzed and reported electronically. The patients generally applied with the complaints of abdominal pain, palpable abdominal mass, and abdominal distention. Fourteen (63.7%) of the cases were male and 8 (36.3%) were female. The mesenteric cysts were located in the small intestine in 18 cases and colon in 4 cases. In the histopathological examination of the surgical materials, simple cyst was detected in 17 cases, lymphangioma in 4 cases, colon adenocarcinoma, and simple cyst in 1 case. In the postoperative period, superficial surgical site infection developed in 3 patients and morbidity developed in 1 patient due to anastomotic leakage. Although mesenteric cysts are rarely seen, although most of them are not histopathologically malignant, they can reach large sizes and require extensive surgical operation, and related morbidities can be seen. Therefore, mesenteric cysts should be followed carefully in the postoperative period as well as during the diagnosis and surgical treatment process.

Primary hydatid cyst of the mesentery presenting as a small bowel volvulus

Hydatid disease mostly caused by Echinococcus granulosus (dog tape worm) is a common parasitic disease in pastoral areas. It produces cysts in the human body. Human is an accidental intermediate host. Most common sites are liver and lungs. Intraperitoneal hydatid cyst occurs sometimes and it is usually secondary to rupture of primary hepatic hydatid cyst. Primary intraperitoneal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. Small bowel volvulus is rare but documented complication of tumours of the mesentery, including cysts. In this article, the authors present a case of primary mesenteric hydatid cyst with acute intestinal obstruction secondary to volvulus.

Small Bowel Mesenteric Pseudocysts: Report of a Case and Review of the Literature

Background: Mesenteric pseudocyst (MP) are rare clinical entity presenting a thick fibrotic wall with internal septae without epithelial lining cells. Case Report: We described one case of MP of a 50-year-old woman with persistent, non-specific, and non-responding to medical therapy abdominal pain. Laboratory tests, clinical examination and the abdominal US were un-conclusive while the CT scan of the abdomen showed a cystic lesion of the jejunal mesentery. We performed a laparoscopic surgical excision of the lesion with the resolution of clinical symptoms. The lesion resulted in inflammatory mesenteric cyst at the histological examination. At 5 years CT scan follow up we did not record any recurrences. Conclusion: MP present themselves without specific symptoms, diagnostic imaging techniques such as US or CT scan may define its features, location or size but fail in determining their benign or malign nature. In fact, even if, the majority of these lesions are benign, a rate of malign transformation of around 3% has been reported, which is why the complete surgical excision is the gold standard treatment.

Benign cyst with xanthogranulomatous inflammation involving the transverse colon and the common iliac artery

Xanthogranulomatous inflammation (XGI) is a rare process. Colonic XGI is extremely rare. We present a case report of XGI arising within an intra-abdominal cyst involving the transverse colon. A 28-year-old man presented with abdominal discomfort. He underwent a computed tomography abdomen–pelvis, which found three subcutaneous collections and a large cystic intra-abdominal structure. The decision was made for resection. Intraoperatively, the cyst originated from the pelvis and was adherent to the surrounding tissues. Histology from the lesion revealed XGI extending into the surrounding tissue. XGI is a rare inflammatory condition. Clinically, it can be difficult to distinguish XGI from an infiltrative malignancy. Therefore, it is usually necessary to obtain a pathological diagnosis of XGI. This case describes an atypical cystic lesion with XGI involving the transverse colon. Although rare, it should be considered in the potential differential diagnosis of an infective or malignant mesenteric cyst.