Laparoscopic excision of mesenteric cyst of sigmoid mesocolon

Unusual acute right abdominal pain. Distal ileum mesenteric cystic lymphangioma in adult, a rare case and literature review

Lymphangiomas in the peritoneal cavity are rare in adults, with most cases occurring in children. We present the case of a 49-year-old woman who was admitted with severe lower abdominal pain. The diagnostic assessment revealed a multiloculated cystic structure in the mesentery of the distal ileum, suggesting a lymphangioma. The patient underwent laparotomy and resection, with successful removal of the mass. Histopathological examination confirmed the diagnosis of intestinal lymphangioma, a rare benign vascular neoplasm of the small bowel. Postoperatively, the patient experienced resolution of postoperative ileus and mild back and abdominal pain, with no complaints during follow-up. Awareness of this uncommon condition is crucial for accurate diagnosis and appropriate treatment. Surgical resection, supported by radiological and histopathological investigations, is the primary treatment modality for symptomatic lymphangioma. Regular follow-up with imaging may be necessary to monitor recurrence.

Intact Excision of a Mesenteric Pseudocyst

Mesenteric cysts are detected in all age groups with almost equal incidence in both genders. Although a rare abdominal growth, it is commonly found in the fifth to seventh decades of life. These are mostly small (asymptomatic) with a 3% chance of malignant transformation. With the increase in the size of the cyst, nonspecific complaints of abdominal pain, distention, discomfort, nausea, vomiting, flatulence, constipation, or diarrhea may develop. Owing to the varied presentation and lack of pathognomonic clinical, laboratory, or imaging findings, these are difficult to diagnose. The subtype mesenteric pseudocyst is even rarer with a reported incidence of less than 1 out of 250,000 hospital admissions and can be found anywhere along the mesentery from the duodenum to the rectum. Etiology is either traumatic or infectious. Incidental diagnosis during abdominal imaging or laparotomy is common. However, it warrants immediate surgical intervention when infected or ruptured. Complete excision of the cyst is the treatment of choice. Here, we report an interesting case of a middle-aged gentleman who had been repeatedly evaluated for a tense abdomen with exudative ascites. Following decompression, he presented to us with a large obliquely mobile mass in the abdomen. The diagnosis was made by clinical and radiological findings and confirmed by histopathological examination of the intact, excised specimen post-laparotomy.

Mesenteric Cyst: A Case Report

Mesenteric cysts are rare benign abdominal lesions that possess the risk of malignant transformation in 3% of reported cases. Most cysts are asymptomatic and diagnosed incidentally or during the management of their complications. In the majority of cases, they arise from the mesentery of the small bowel, followed by the mesocolon. We present a case report of a 20-year-old female with an abdominal mesenteric cyst.

Case report: A mesocolic lymphangioma in a 14-year-old child resected by laparoscopic surgery

Introduction

Cystic lymphangioma is a benign malformation tumor of the lymphatic system. Its location is variable, and mesocolic localization remains extremely rare.

Case presentation

We report a case of right mesocolon giant cystic lymphangioma in a previously healthy 14-year-old boy who was successfully managed through a minimally invasive laparoscopic excision. The patient presented with 8 months of dull abdominal pain, sporadic, located on the peri-umbilicus, exacerbated for a month. An abdominal computed tomography (CT) revealed a large, multiseptated cystic mass on the right mesocolon. Right mesocolic excision using a laparoscope was performed on this patient. He was discharged on the fifth day without complications. Recurrence was not detected in three months of follow-up.

Conclusion

Cystic lymphangiomas in the mesocolon are rare benign neoplasms that pose diagnostic challenges. Complete resection is the optimal option for diagnostic confirmation and recurrence prevention. Laparoscopic surgery is feasible for children with mesocolic lymphangioma.

A Rare Case of a Mesenteric Cyst

A mesenteric cyst is an uncommon ailment that can affect practically any abdominal quadrant in its presentation. They may turn up as an accidental discovery. Although there are a number of hypotheses explaining the genesis of these cysts, the exact etiology is unknown. A 70-year-old female patient came to see us complaining of abdominal pain for a month and had trouble passing stools for 15 days. Contrast-enhanced computed tomography was done for the patient, which revealed a heterogeneously enhancing mass lesion in the abdominal cavity. The patient was then taken for an exploratory laparotomy procedure. To make the procedure thorough and easy, intraoperative partial drainage of the cyst fluid was carried out. We were able to observe the margins of the mesenteric cyst more easily as the partial drainage was carried out. The partial drainage decreased the volume and size of the mesenteric cyst, reducing the pressure effect on the surrounding structures and allowing easy mobilization of the intraabdominal structures during intraoperative examinations. The partial drainage of the cystic fluid also made the dissection process safer. After releasing all adhesions, the cyst was delivered outside and sent for histopathological analysis. The histopathological reports confirmed it to be a mesenteric cyst. The aim of this article is to educate the readers and to make fellow surgeons well aware of this condition. This will not only help fellow clinicians in better diagnosis and treatment but also help in the reduction of the overall burden of the healthcare society by reducing mortality and morbidity.

Laparoscopic Treatment of Mesenteric Cysts: Report of Two Cases With a Literature Review

Introduction

Mesenteric cysts are rare intra-abdominal masses. They do not show classic clinical findings and are detected incidentally during imaging because of their absent or nonspecific clinical presentation. We herein report 2 cases of mesenteric cysts that were successfully diagnosed and resected through a laparoscopic approach.

Case presentation

In a 35-year-old man underwent a comprehensive medical checkup at another hospital, during which ultrasound incidentally revealed a cystic mass in his right retroperitoneum. The patient was referred to our hospital for surgical treatment. He was asymptomatic and his medical history was unremarkable. Physical examination revealed no palpable abdominal mass, and all laboratory test results were within normal ranges. Contrast-enhanced computed tomography showed a 7.2-cm-diameter smooth-surfaced, well-demarcated mass behind the right colon without a contrast effect (Fig. 1). We considered the cyst to be benign and localized in the mesentery of the ascending colon. In one patient, the cyst was located in the mesentery of the ascending colon and removed via a right hemicolectomy; in the other patient, the cyst was located in the sigmoid mesentery, which was completely resected through the operative wound under an open procedure after laparoscopic mobilization of the sigmoid mesentery. We chose the laparoscopic approach in both cases because the cysts were considered benign, noninfectious, and nonhemorrhagic. Histologic examination revealed cystic lymphangioma in both cases.

Conclusion

For mesenteric cysts, laparoscopy could be a preferred approach in properly selected patients.

Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain-A case report

INTRODUCTION

Mesenteric psuedocysts are rare tumors of the gastrointestinal mesentery that are seldom symptomatic. Although these benign tumors are most commonly found incidentally during work-up for other pathology, they can be troublesome in select patients based off size, location and risk of malignant transformation. This case is reported in accordance with SCARE Criteria [1].

PRESENTATION OF CASE

A 24 year-old-male presents with life-long migratory abdominal pain presents with a one week history of acute pain associated with nausea. Computed tomography revealed free fluid in the pelvis and a thin-walled mesenteric cyst within the left, mid-abdominal mesentery measuring approximately 4.3 × 4.0 × 4.0 cm. The patient was admitted for resuscitation and planned delayed operative intervention.

DISCUSSION

The patient underwent complete open enucleation secondary to location and in an attempt to limit injuries to or resection of small bowel. Pathological analysis revealed a mesenteric cyst with fluid culture positive for Propionibacterium acnes without true cystic wall consistent with an infected mesenteric pseudocyst. These lesions are difficult to diagnose secondary to varied presentation and lack of pathognomonic clinical, laboratory and imaging findings. Mesenteric pseudocyst have a low rate of recurrence after removal; however, surgical management is mandated due to risks of malignant transformation.

CONCLUSION

This is a rare case of a mesenteric pseudocyst of small size presenting with lifelong abdominal pain secondary to its location near the root of the mesentery and inflammatory reaction secondary to infection. It is important to maintain a high index of suspicion for mesenteric cyst as many complications may result if misdiagnosed or without proper surgical management.

Case-report: A rare cause of an intra-abdominal mass

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Mesenteric cysts may present with symptoms of early saiety and bloating.

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Mesenteric cyst anatomy may be difficult to delineate on Ultrasound imaging alone.

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Mesenteric cyst drainage and marsupialisation is a safe alternative to excision.

Introduction

Mesenteric cysts are a rare and often asymptomatic incidental finding on imaging. The diagnosis and management of mesenteric cysts remains a clinical challenge since those presenting with symptoms, often have vague and nonspecific symptoms, owing to variability in cyst location and size. This case report will aim to discuss the presentation, investigation and management options available.

Presentation

A 73-year-old female presented with abdominal swelling and a palpable right sided mass. Examination revealed a right sided mass and abdominal distention with vital signs within normal limits. Ultrasound scan (USS) revealed a right-sided 12 cm × 11 × cm × 8 cm thin walled cyst.

Discussion

Mesenteric cysts are mostly asymptomatic but can cause nonspecific symptoms of abdominal pain, abdominal distension, altered bowel habit, nausea, vomiting and an abdominal mass. Complete surgical excision, either laparoscopically, or through a laparotomy is typically considered first line treatment. If size or location of the cyst precludes complete surgical excision, partial excision with marsupialisation of the opening of the cyst into the abdominal peritoneal cavity is a second option.

Conclusion

Mesenteric cysts represent a rare cause of intra-abdominal mass. Owing to low prevalence, literature is limited as is guidance on management. Careful pre-operative planning is essential so as to avoid operative complications. Imaging such as USS is of great importance; however Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) may be of more benefit, owing to the complex anatomical relations within which mesenteric cysts can present. Surgical excision is widely reported as the surgical treatment of choice for symptomatic cysts.

Novel diagnosis of mesenteric endometrioma: Case report

RATIONALE

Mesenteric cysts are benign gastrointestinal cystic lesions, with an incidence of <1/100 000. They usually develop in the small bowel mesentery, mesocolon (24%), retroperitoneum (14.5%), and very rarely originate from the sigmoid mesentery. Endometriomas represent a localized type of endometriosis and are usually within the ovary. Our case is unique because there are no reports in the literature of endometrial mesenteric cysts.

PATIENT CONCERNS

We present a case of a 29-year-old woman who underwent a routine gynecologic control.

DIAGNOSIS

Clinical examination and imaging identified 2 endometriomas on the left and posterior to the uterus.

INTERVENTIONS

The patient underwent exploratory laparoscopy. Unexpectedly, a 10 cm mesenteric cyst was identified; this was associated with adhesions in the left adnexal area and a left ovarian endometrioma. The classic surgical approach which was necessary identified the mesenteric cyst with cranial mesosigmoid and ileal adhesions, as well as distal adhesions which included the uterus, ileum, left ovarian endometrioma, left hydrosalpinx, left ureter, and rectum. The cyst was removed completely and a left adnexectomy was performed because of the presence of the endometrioma and adhesions.

OUTCOMES

The patient's outcome was favorable, with discharge at 72 hours after surgery. The histopathological report revealed that both the mesenteric and ovarian cysts were endometriomas.

LESSONS

Our case is unusual in that a mesenteric cyst was identified in a patient with no clinical symptoms. Furthermore, the histopathological examination revealed the endometriotic origin of the mesenteric cyst which has not previously been reported in the literature.

Giant sixteen kilogram lymphangioma mesenteric cyst: An unusual presentation of a rare benign tumour

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Mesenteric cysts may present as giant abdominal masses.

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It is the heaviest (16 kg) mesenteric cyst reported in the literature to date.

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In low incomes countries, the interval between the onset of symptoms and consultation is often significant, leading to unusual presentations.

Background

Mesenteric cysts are rare abdominal benign tumours with an incidence of 1:100.000–250.000 surgical admissions located in the mesentery. Theirs presentations may range from incidental asymptomatic discovery during imaging to non-specific abdominal symptoms.

Case presentation

We present the case of a 46 year old female who presented with 9 months history of progressive abdominal distension. CT scan showed a giant abdominal mass. After the necessary preoperative work up, a midline incision laparotomy was performed. Intraoperative findings were a mesenteric cyst originates from the transverse mesocolon. The cyst weighed 16 kg and histopathology analyses confirmed a lymphangioma mesenteric cyst.

Discussion

In low incomes countries like our own, the interval between the onset of symptoms and consultation is often significant, leading to unusual and sometimes spectacular presentations at the time of diagnosis. To our knowledge, it is the heaviest mesenteric cyst reported in the literature to date.

Conclusion

Mesenteric cysts may present as giant abdominal masses. The publication of this atypical case is a plea for us for the establishment of universal health coverage in our country in particular and in Africa in general.

Retroperitoneal or mesenteric primary liposarcoma: clinical and prognostic evaluations on five cases

BACKGROUND

Retroperitoneal or mesenteric primary liposarcoma is a malignant neoplasia whose prognosis depends on the biological variants, the radical resection surgery and the histological subtypes, as well as on local and remote recurrences. Liposarcoma is the most common variant of this tumour among tumours of soft retroperitoneal tissue. The purpose of this study is to evaluate whether the treatment of this disease, carried out at the Ivrea Hospital for urgent reasons, may be considered in line with the experience of high-volume Centres.

PATIENTS AND METHODS

Between 1982 and 2016 five patients were hospitalized with a diagnosis of acute abdomen due to retroperitoneal or mesenteric primary liposarcoma: one myxoid of the mesentery, one well-differentiated of lesser epiploon, one well-differentiated of mesentery, and two dedifferentiates of the retroperitoneum.

RESULTS

The five patients, all males, had a average age of 59 years (range 48-86) and were all subjected to general anaesthesia and open technique for total tumour removal. Only the patient with the myxoid liposarcoma had two recurrences. All are alive and healthy after a follow-up of 177 months (range 9-420).

CONCLUSION

These tumours should be removed radically, if necessary in conjunction with contiguous organs. Rarity and therapeutic complexity require a treatment, sometimes even multimodal, in highvolume centres. Patients admitted in General Surgery Unit for unpostponable urgency should be operated by surgeons experienced in the treatment of abdominal disease to achieve survival results in line to those achievable in Hub Centres.

Mesenteric cysts and mesenteric venous thrombosis leading to intestinal necrosis in pregnancy managed with laparotomy: a case report and review of the literature

Background

Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation.

Case presentation

A 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks’ gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day.

Conclusions

To the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians should bear in mind this rare clinical condition in their diagnostic algorithm for acute abdominal pain.

A mesocolonic lymphangioma in an adult with peritonitis: a case report

Cystic lymphangiomas of the mesocolon are very rare in adults. They are usually asymptomatic, but can present with an acute abdomen. We report an adult patient with cystic lymphangioma of the mesocolon that manifested with peritonitis. A 33-year-old man presented with fever and severe pain with muscle guarding in the left abdomen. Laboratory data indicated high-grade inflammation. Enhanced computed tomography (CT) showed multiple low-density masses with peripherally enhancing rims, strongly suspicious for cysts, in the left abdomen. Based on a diagnosis of peritonitis, emergency surgery was performed and revealed many cysts in the descending mesocolon. Histopathological examination findings indicated a cystic lymphangioma. The post-operative course was uneventful, and 1-year follow-up CT showed no recurrence. This case demonstrates that cystic lymphangiomas of the mesocolon in adults can present with acute peritonitis, although this is extremely rare. Complete resection is required for accurate diagnosis and for preventing recurrence.

Case report: elective removal of a large mesenteric cyst-our approach

A mesenteric cyst is rare intra-abdominal pathology, with little literature to guide us on how to diagnose and manage it. We report the incident of a 57-year-old female who had an incidental finding of a sigmoid mesenteric cyst whilst undergoing an operation under the care of the Gynaecologists. A computed tomography scan and a flexible sigmoidoscopy followed to help diagnose the lesion as a cyst. A month later the 10 × 15 cm² cyst was excised laparoscopically with no complications.

The mesentery: structure, function, and role in disease

Systematic study of the mesentery is now possible because of clarification of its structure. Although this area of science is in an early phase, important advances have already been made and opportunities uncovered. For example, distinctive anatomical and functional features have been revealed that justify designation of the mesentery as an organ. Accordingly, the mesentery should be subjected to the same investigatory focus that is applied to other organs and systems. In this Review, we summarise the findings of scientific investigations of the mesentery so far and explore its role in human disease. We aim to provide a platform from which to direct future scientific investigation of the human mesentery in health and disease.

Mucinous mesenteric cyst of the sigmoid mesocolon: a rare entity

Mesenteric cysts are rare and occur in patients of any age. They are asymptomatic and found incidentally or during the management of their complications. They commonly originate from the small bowel mesentery, although a proportion has been found to originate from the mesocolon (24%) and retroperitoneum (14.5%). A mesenteric cyst originating in the sigmoid mesocolon is a very rare finding.

Laparoscopic resection of a jejunal mesenteric pseudocyst: case report

Mesenteric cysts are rare and can occur at any age. They can manifest with abdominal pain or compressive mass effect. The exact etiology is unknown. Ultrasonography, computed tomography and laparoscopy are used in diagnosing mesenteric cysts. Laparoscopic excision of a mesenteric cyst is possible and should be considered as the treatment of choice. We present a case of mesenteric pseudocyst of small bowel treated by laparoscopic excision.