Mesenteric cysts. A case treated by laparoscopy and a review of the literature

Childhood mesenteric cyst: A rare intra-abdominal entity with literature review

INTRODUCTION AND IMPORTANCE

Mesenteric cysts are uncommon intra-abdominal benign masses that appear in childhood with varying degrees of clinical manifestations, ranging from being asymptomatic to presenting as an acute abdomen. The diagnosis is made incidentally during the work-up for other abdominal pathologies such as acute appendicitis, bowel obstruction, etc. The treatment is mostly surgical and varies depending on the clinical type of the lesion.

CASE PRESENTATION

A 26-month-old child was referred to our teaching hospital's pediatric surgery department with an abdominal mass. The patient had previously complained of constipation and been treated symptomatically with laxatives. Ultrasonography reported ovarian cysts confirmed by computerized tomography scanning (as a misdiagnosis report of an ovarian cyst instead of a mesenteric cyst), done outside the hospital in a private diagnostic center.

CLINICAL DISCUSSION

The patient was prepared for operation and during the surgical procedure, she was found to have a duplex cyst, which was mostly incorporated in the mesentery of the distal 1/3 of the transverse mesocolon. The cyst was enucleated through a lower midline laparotomy incision without bowel resection and anastomosis. The histopathological analysis of the specimen confirmed a mesenteric cyst.

CONCLUSION

Mesenteric cysts are rare lesions in children and should be considered when approaching any intra-abdominal mass. Except for the rare cases where intestinal resection and/or partial cyst excision are required, all mesenteric cysts can be excised while preserving intestinal integrity and vascular supply.

An accidental finding of a giant intra-abdominal mass

INTRODUCTION

Mesenteric cysts are rare intra-abdominal tumours often found incidentally on imaging studies or during surgery. The clinical presentation is various with most subjects being asymptomatic, but complications can occur such as torsion, rupture, hemorrhage or obstruction of nearby structures. The etiology of mesenteric cysts remains uncertain. Complete surgical resection is preferred, although there are no specific guidelines concerning optimal treatment strategy.

CASE REPORT

We present a 61-year-old male with type 2 diabetes mellitus who underwent a routine abdominal ultrasound examination which accidentally uncovered a large mass. The patient had no complaints nor any physical discomfort. Magnetic resonance imaging and computed tomography revealed a giant thin-walled cyst with multiple septa spanning 24 × 24 cm² originating from the mesentery. The primary differential diagnosis included a mesenteric cyst, a hydatid cyst due to echinococcus or malignancy. After multidisciplinary team approach, open surgical exploration was preferred. Surgical drainage and cyst sac resection were performed without any peri- or postoperative complications. Histopathology confirmed the presence of a large mesenteric cyst, probably caused post-traumatically. The patient has made a full recovery.

CONCLUSION

Mesenteric cysts can develop asymptomatically and reach enormous proportions. They are often found accidentally. Imaging studies aid in the differential diagnosis, but histopathology remains the diagnostic gold standard. Surgical resection prevails compared to a conservative approach due to the risk of complications. The choice between open or laparoscopic surgery should be determined based on the perioperative risk.

Mesenteric Cyst in 22 Cases

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Male infant patient with a mesenteric cyst in the greater and lesser omenta: a case report

Background

Mesenteric cysts are intra-abdominal masses of congenital origin, which most frequently occur in children, with an incidence of approximately 1 case per 20,000 pediatric admissions. Its progression can be asymptomatic, and its diagnosis can be incidental. However, it usually occurs with symptoms such as nausea, vomiting, constipation, sensation of a mass, and/or diarrhea. The diagnostic imaging method of choice is abdominal ultrasound.

Case presentation

Below, we present the case of a previously healthy 1-year-old male patient with nonspecific symptoms, who was referred to a tertiary hospital. The presence of a mesenteric cyst was detected at the end of the diagnostic approach.

Conclusion

It is important to know these pathologies even though they are infrequent, because although they are benign masses by definition, they can lead to complications such as intestinal torsion, intestinal obstruction, and even peritonitis.

A Case of Mesenteric Cyst in a 4-Year-Old Child with Acute Abdominal Pain

Mesenteric cysts are rare intra-abdominal lesions occurring during childhood, which were first described in 1507. Cases of mesenteric cysts have been continuously reported, but these cases were very small in number. They are often asymptomatic and incidentally found while patients are undergoing work-up or receiving treatment for other conditions such as appendicitis, small-bowel obstruction, or diverticulitis; however, patients may still have lower abdominal pain and symptoms that are frequently associated with other abdominal conditions. The symptoms are variable and non-specific, including pain (82%), nausea and vomiting (45%), constipation (27%), and diarrhea (6%). An abdominal mass may be palpable in up to 61% of patients. We are to report the clinical course and literature of a child with mesenteric cysts who complained of acute abdominal pain, distension, and vomiting and were surgically treated after being diagnosed with mesenteric cysts based on radiological examination.

Percutaneous drainage and sclerosis of mesenteric cysts: literature overview and report of an innovative approach

We present the case of a 29-years-old male patient, affected by a voluminous post-traumatic mesenteric cyst, a rare abdominal disease; our patient represents a rarely affected age group. Treatment was based on interventional radiology with an US-guided drainage and sclerosis by ethyl alcohol of the lesion. The intervention performed on this patient represents the application of a standardized radiological technique to a new contest, mesenteric cysts, whose gold-standard treatment is represented in literature by surgery. In our case we obtained an optimal result, with complete regression of the treated cyst: it proved to be an effective, feasible, safe and minimally invasive procedure.

[Mesenteric cyst--clinical and pathological aspects]

OBJECTIVE

To evaluate epidemiologic, clinical, pathologic and therapeutic characteristics of the mesenteric cysts in hospitals of Sergipe, Brazil.

METHODS

Mesenteric cysts were assessed by a non-interventional cross-sectional study from the archives of the Pathology Laboratory of Federal University of Sergipe between 1995 and 2007. The charts of the patients were reviewed in order to find out: gender, age, clinical findings, complementary exams and therapeutic approach.

RESULTS

Eighteen cases of mesenteric cysts were found. Females were more affected (72.2%). Mean of age of the patients was 30.46. More frequent symptoms were pain and abdominal mass. Ultrasonography of abdomen, performed in all patients, was not conclusive in half of the cases. CTscan of abdomen with contrast was performed in six cases, being cystic tumor well identified in all of them. Regarding histopathology, 6 lymphangiomas, 8 mesotheliomas, 1 hemorrhagic cyst in organization and 1 mucinous cyst were found. Surgical treatment was performed in all cases. Intracystic bleeding was the main complication in 3 cases.

CONCLUSION

The mesenteric cysts presented clinically with unspecific symptoms. CTscan was more effective than ultrasonography for the diagnosis. Lymphangiomas and mesothelioma had been found in equal ratios. The complete resection of the cyst was the treatment of election. There were no deaths in postoperative period.

Large mesenteric cyst mimicking tuberculous ascites

Background. Intraabdominal lesions such as mesenteric cysts are uncommon disorders. Most are discovered incidentally during routine abdominal examinations. Methods. We report a patient with a mesenteric cyst masquerading as tuberculous peritonitis and ascites. Conclusion. Mesenteric cysts generally do not show typical clinical findings. They may also present with peritoneal tuberculosis findings such as low albumin gradient ascites with high ascitic adenosine deaminase levels. Surgery is used to remove a wide variety of mesenteric cysts. A correct diagnosis can be made by the combined use of radiographic and sonographic examinations in conjunction with the clinical signs.

A rare case of acute abdomen

Mesenteric cysts are tumoural formations which are generally benign in character, originate from the intestinal mesentery, and rarely cause abdominal tumours. They are asymptomatic unless a complication occurs, and thus may be incidentally diagnosed. Symptomatic cases may show up with findings such as abdominal pain, abdominal mass, nausea, and vomiting, and sometimes patients present with an acute abdomen. Treatment includes total excision of the cyst. We present the case of a male patient admitted to our emergency department with acute abdominal symptoms, who was subsequently found to have a mesenteric cyst measuring 30×20×9 cm.

Laparoscopic management of mesenteric cyst: a case report

Mesenteric cysts are rare intra-abdominal lesions with variable clinical symptoms and signs that make pre-operative diagnosis difficult. Optimal treatment is surgical excision of the cyst with laparotomy or laparoscopy. We present a case of mesenteric cyst that was misdiagnosed as para-ovarian cyst and managed laparoscopically by gynaecologists.

Laparoscopic treatment of a huge cystic lymphangioma: partial aspiration technique with a spinal needle

A cystic lymphangioma is a rare intra-abdominal lesion. Treatment is a complete excision of the cyst because of complications and a rare chance of malignancy. In this paper we report on 2 patients with a huge cystic lymphangioma who were treated by laparoscopic surgery successfully. Each of the cysts were 13 and 11 cm in diameter, were diagnosed by ultrasonography and computed tomography scan. After partial aspiration of the cysts, using a spinal needle, we were prone to grasp the cysts without spillage. Traction and dissection were easy without spillage or injury of the mesenteric vessels. The laparoscopic approach can be successfully and safely performed by an experienced surgeon in keeping with oncologic principles.

Urinary retention due to mesenteric cyst: An extremely unusual presentation of a rare complication

Mesenteric cysts are rare intra-abdominal masses, presenting with various clinical signs and symptoms. Mesenteric cysts presenting with a sudden onset of urinary retention is extremely rare. There are no cases reported in the English literature. Here, we report a very rare case of urinary retention, due to mesenteric cyst in a 19-year-old man. The patient presented with abdominal distention with a sudden onset of urinary retention. Ultrasonography and computed tomography scan of the abdomen revealed a huge cystic mass above the bladder that was completely separated from the kidney and bladder. The cyst was removed surgically. The patient experienced no urological difficulty after the surgery. Histological examination confirmed the diagnosis of a mesenteric cyst.

Mesenteric lymphangioma presenting as adnexal torsion: case report and literature review

We report the case of a patient with a mesenteric chylous lymphangioma who presented with acute pelvic symptoms mimicking adnexal torsion. The cyst contents had no specific sonographic or CT characteristics, such as a fluid-fluid level, to aid the preoperative diagnosis; definitive diagnosis was made only upon histopathologic examination of the cyst, which was resected intact.