"Mesenteric cyst: A rare intra-abdominal tumour"

A clinician's perspective on the new organ mesentery and non-vascular mesenteropathies

Mesentery was discovered as a new organ in 2017. It is a continuous membranous tissue from the duodenojejunal flexure to the anorectal junction. It has distinct anatomy, physiology, and disease states. Primary mesenteropathies include vascular and non-vascular diseases. Some of them are common, and some of them are rarely seen in clinical practice. Secondary mesenteropathies occur when infection or malignancy in another organ spreads to the mesentery. Each entity has specific diagnostic and treatment protocols. Increased awareness of different mesenteropathies and an understanding of their various presentations at different stages of life can help in early diagnosis and improved clinical outcomes.

Neonatal mesenteric cyst in a 5-day-old patient: a case report

Mesenteric cysts have been documented as a rare occurrence in children. They are mostly renowned to be benign intra-abdominal tumors with no known etiology. The symptoms are non-specific ranging from being asymptomatic to an acute abdomen. Most of the diagnoses are made below the age of 10 years with devoid of reports for the early neonatal occurrences. We report a case of an early neonatal mesenteric cyst in a 5-day-old female patient who presented with signs of intestinal obstruction markedly by abdominal distension, vomiting, and absolute constipation. Abdominal X-ray showed evidence of small bowel obstruction while abdominal ultrasound and computed tomography (CT) scan were used to reach the diagnosis of a mesenteric cyst, all laboratory baseline investigations were within a normal range. On laparotomy a 12 by 13 cm cyst that was firmly adhering to the proximal ileal wall was meticulously dissected, complete cystectomy was done with no segmental resection. Histopathologically there were no signs of malignancy and the patient successfully recovered with no signs of recurrences after being followed for a year and a half. Being a rare case in the early neonatal period with unspecific presentations; mesenteric cyst should be considered as one of the diagnoses best to be managed by surgical excision to prevent recurrences.

Omental mature cystic teratoma mimicking a mesenteric cyst: A case report

Mature cystic teratomas (MCTs) arise from totipotent cells. While the ovaries are the most common sites, extragonadal teratomas are very rare. This case report describes the clinical details of a 20-year-old woman who was found to have a large pelvi-abdominal mass on clinical and imaging studies and elevated levels of CA-125. Because of the uncertainties of the origin of the mass, a multidisciplinary team suggested exploratory laparotomy with a mesenteric cyst as a differential diagnosis. Laparotomy showed both ovaries to be normal and revealed a large omental MCT, which was excised. Histopathology confirmed the diagnosis.

Chylolymphatic mesenteric cyst: A rare differential diagnosis of cystic mass in abdomen: A case report

INTRODUCTION

Mesenteric cysts are the rare benign intraperitoneal tumor, which are common in the mesentery of the terminal ileum. Though mesenteric cysts are frequently seen, chylolymphatic mesenteric cysts in children are rare entities.

CASE PRESENTATION

Our case is a case of a 3-year-old female child presenting to our center with a complain of abdominal pain. Ultrasonography (USG) of the abdomen revealed a cystic lesion in the right upper abdomen, and computed tomography (CT) scan showed a large homogenous fluid density lesion in the right upper abdomen, giving a provisional diagnosis of mesenteric cyst. She was managed surgically: the cyst was excised, the involved segment of bowel was resected and the remaining was anastomosed. On histopathology, the final diagnosis of a chylolymphatic mesenteric cyst was made.

DISCUSSION

Clinical presentations may vary from asymptomatic abdominal lump to features of acute abdomen. Imaging modalities like ultrasonography and computed tomography scans are the mainstay of investigations. Surgical management with excision of cyst, and resection of the involved bowel segment is the treatment of choice, as done in our patient. The final diagnosis is made after the histopathologic examination of the excised specimen.

CONCLUSION

Chylolymphatic mesenteric cysts are rare, and have varied clinical presentations. Although rare, chylolymphatic mesenteric cysts should be considered a differential diagnosis in patients presenting with cystic masses in the abdomen.

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: A Case Report of a Healthy, Five-Year-Old Patient

Mesenteric and omental cysts can be seen at any age, with one in three cases seen in patients under 15 years old. These cysts represent one in 20,000 pediatric admissions. Here we share the case of a five-year-old female patient at a health center in a developing country, with the purpose of contributing to documentation in the region.

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.

A Rare Case of Abdominal Tumor: Mesenteric Cyst

Mesenteric cysts are rare, usually benign, tumors that typically present asymptomatically and are found incidentally during evaluation for nonspecific abdominal symptoms. We present the case of a 41-year-old African American female who was found to have a mesenteric cyst in her jejunum during the evaluation of abdominal pain, nausea, and constipation that she had been experiencing for six weeks. Pre-operatively, an abdominal CT scan showed a 6x4x6 cm mesenteric cystic lesion in the right mid-abdomen, which was then successfully resected off the mesentery of the jejunum laparoscopically. Her postoperative course was uneventful and she was discharged home without complication a few hours after her procedure with appropriate follow-up. 

Idiopathic lymphatic mesenteric cyst of the proximal jejunum: A case report of an unusual clinical presentation

INTRODUCTION

Mesenteric cysts are rare lesions of the abdominal cavity or retroperitoneum. The exact etiopathogenesis is still undefined. Clinical manifestation can vary from asymptomatic patients to symptoms of an acute abdomen, making diagnosis very challenging.

CASE PRESENTATION

We present a case of a 47-year-old male with new ongoing polyuria and nocturia as well as episodes of slight abdominal pain. An abdominal ultrasound showed ascites and the computer tomography (CT) scan raised suspicion of an internal hernia. We performed a diagnostic laparoscopy and open resection of a cystic lesion of the small bowel mesentery. The histological examination revealed a lymphatic mesenteric cyst.

DISCUSSION

Mesenteric cysts represent rare intra-abdominal tumors that physicians should consider as a differential diagnosis in patients with abdominal pain and an intra-abdominal mass.

CONCLUSION

Surgery should be advised to prevent the development of complications and to confirm the histopathological diagnosis.

Quiste mesentérico gigante como simulador de ascitis: reporte de un caso y revisión de la literatura

Introducción. Los quistes mesentéricos son tumores poco frecuentes y usualmente benignos, que se diagnostican principalmente en la edad pediátrica, de manera incidental. Caso clínico. Se presenta el caso de una paciente de cuatro años de edad, con dificultad para acceso a servicio de salud por localización de su vivienda, quien cursa con un cuadro clínico de dos años de evolución de distensión abdominal progresiva, interpretada y manejada como ascitis. Se realizó una tomografía de abdomen en la que se documentó una lesión quística gigante, por lo que fue llevada a resección por laparotomía, con confirmación histopatológica de un quiste mesentérico. Discusión. Los quistes mesentéricos pueden tener cualquier localización en el mesenterio del tracto gastrointestinal. Su principal etiología es la proliferación anormal y benigna de tejido linfático mesentérico. Las manifestaciones clínicas van desde la ausencia de síntomas hasta el abdomen agudo. Dentro de los síntomas abdominales no agudos se encuentran masa abdominal indolora, dolor abdominal, distensión abdominal y signos clínicos que simulan ascitis. La resección completa del quiste mesentérico es considerada el tratamiento de elección; el abordaje laparoscópico o abierto dependerá de las características clínicas de cada paciente y la experiencia del cirujano tratante. Conclusión. Es importante que los cirujanos conozcan las principales características y el manejo de esta entidad, que una vez presente, puede simular un síndrome ascítico.

Mesenteric Cyst with GI Symptoms: A Fluid Approach to Treatment-Case Report and Literature Review

Mesenteric cysts are defined as a heterogeneous group of intra-abdominal cystic lesions of the mesentery or omentum that may be found in any portion of the gastrointestinal tract from the duodenum to the rectum. The clinical condition is entirely asymptomatic in many patients, particularly with small cysts. The diagnosis is typically incidental and secondary to imaging performed for other purposes. In symptomatic patients, the clinical picture is characterized by nonspecific gastrointestinal signs and symptoms. Treatment may be surgical or via interventional radiology. We report the case of a 55-year-old female patient complaining of left-sided abdominal discomfort and constipation lasting three months. An abdominal ultrasound showed the presence of a 10 × 14 × 16 cm anechoic cystic mass filling the whole anterior and left abdominal cavity, confirmed by CT and MRI. The cyst, removed laparoscopically, was histologically a simple mesothelial cyst. We reviewed the international literature over the last 10 years of all cases with mesenteric cysts > 10 cm in evaluating gastrointestinal symptoms at diagnosis, histology, performed treatment, and outcome.

Mucinous Cystic Neoplasm of Mesentery: A Case Report

Mucinous cystic neoplasms are very rare tumours. They may originate from ovaries, pancreas or other intra-abdominal sites but they rarely originate from the mesentery. They can be asymptomatic or present as an abdominal mass or abdominal pain. We present the case of a 28-year-old woman who presented with epigastric pain and cystic mass per abdomen with a diagnosis of mesenteric cyst made on further imaging studies. Subsequent excision and histopathological analysis demonstrated the cyst to be a mucinous tumour arising from the mesocolon. Mesenteric cyst must be considered as one of the differentials in abdominal cystic lesions. 

Massive Abdominal Distension in a Five-Year-Old Child: Management of a Giant Mesenteric Cyst

Mesenteric cyst is a rare entity with a very low incidence. The majority of the cases are incidental. Despite several theories, its etiology remains unknown. Some cases present with non-specific symptoms such as pain abdomen, swelling, and abdominal mass. It may rarely get complicated due to hemorrhage, torsion, or rupture of the cyst. Large mesenteric cysts are quite uncommon. However, these cysts seldom grow to produce clinical symptoms arising from compression of adjoining structures, such as vomiting, constipation due to intestinal obstruction, or dyspnoea due to compression of the diaphragm. Despite several theories, its etiology remains unknown. Diagnosis can be achieved with the help of radiological examinations such as ultrasonography (USG), contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and confirmed by histopathological examination. We report a case of a giant mesenteric cyst in a five-year-old girl.

Bubbles in the belly- a case based approach to cystic peritoneal masses

Background

Primary cystic neoplasms of the peritoneum are rare lesions and not commonly encountered in practice. Many intra-abdominal processes may mimic cystic masses within the peritoneal cavity and pose a diagnostic challenge to both the pathologist and radiologist. Clinical presentation is diverse and varied. These lesions are usually benign. Hence complete surgical excision is the treatment of choice in most of the cases.

Methods

Study design: Descriptive Retrospective study.

Cystic peritoneal lesions were identified and studied from data over a period of 5 years in the Histopathology Section at a tertiary care hospital in Pune, India. Mode of presentation, imaging findings in addition to gross and histopathologic findings of these lesions were studied.

Results

Out of 50 peritoneal lesions studied over a period of 5 years, only 7 were identified to be cystic peritoneal masses.

Of these two were found to be peritoneal cysts, two mesenteric cysts, one an infected mesenteric cyst and one each a mucinous cystadenoma and lymphangioma.

Conclusions

Correct diagnosis rests in the hands of the pathologist and ensures that the patient receives appropriate and timely management. Hence knowledge of the spectrum of these rare cystic peritoneal masses is necessary to distinguish from other potential cystic abdominal mimicker masses and avoid a potential pitfall.

Mesenteric Cystic Lymphangioma in Pediatric Patient: A Rare Intra-Abdominal Tumor Management in Rural Country Case Report

Introduction: Mesenteric Cystic Lymphangioma (MCL) is a benign malformation of the lymphatic system. MCL seldomly occurs with a very rare incidence of around 1: 250,000. This neoplasm is more common in pediatric patients. Symptoms can appear with various clinical features ranging from asymptomatic abdominal mass to acute abdomen. Case description: Here we report a patient with MCL: that presented with bilious vomiting, abdominal pain, and abdominal mass. The patient underwent explorative laparotomy, mass excision, and  jejunal resection. Discussion: Although benign, MCL can cause other symptoms such as bleeding, torsion, or lymphangioma rupture. Therefore, MCL should be considered as one of the differential diagnoses in acute abdominal and abdominal mass cases in children. Conclusion: In conclusion, although sometimes asymptomatic and found incidentally, the MCL should be resected because it has the potential to grow and invade vital organs and cause life-threatening complications.

Painful Abdominal Lump in the Pediatric Age Group: A Diagnostic Dilemma

Any cystic lesion occurring in the mesentery which may or may not extend into the retroperitoneum is referred to as a mesenteric cyst; they have an infrequent incidence rate in the pediatric age group. Definitive etiology of the cystic lymphatic malformations is still not known but there are multiple hypotheses. A young male child presented with acute onset abdominal pain and palpable intra-abdominal mass and ultrasonography revealed presence of two lesions, one of them as an encysted turbid fluid collection in the right lumbar region and the other as a dilated, tortuous, intercalated structure. On CT, the first one was identified definitively as a mesenteric cyst while the other as a possible neoplastic mass in close proximity to the first one. Histopathology confirmed the diagnosis as a cystic lymphatic malformation of the mesenteric cyst. The limited awareness of its existence along with its usually asymptomatic nature, are the likely reasons that it still remains an elusive diagnosis. Based on our case we discuss, the use of a multi-modality approach towards diagnosing cystic malformation disorders and how the use of MRI is under-utilised when it could prove decisive.

A Case of A Mesenteric Cyst Mimicking a Biloma

Mesenteric cysts are a rare entity, with approximately 1,000 cases reported in the literature. Its etiology is unknown but was theorized to be a benign ectopic lymphatic proliferation in the mesentery. Imaging with surgical excision and pathologic microscopic evaluation is needed for diagnosis, but no specific guidelines for its management have been documented. Per most cases in the literature, drainage of mesenteric cysts is suboptimal and associated with increased risk of recurrence and infection, making surgical resection the treatment of choice. With its varying locations and presentations, diagnosis can be tricky especially given the rarity of its occurrence. Differential diagnosis includes pancreatic pseudocyst, hemangioma, choledochal cyst, hydatid cyst, cystic teratoma, etc. We present a 35-year-old woman who came in with worsening right upper quadrant (RUQ) pain due to chronic cholelithiasis and was found to have a large RUQ cystic mass adherent to the gallbladder, suggesting possible biloma or pancreatic pseudocyst; however, tissue analysis was positive for a mesenteric cyst.

Lymphatic Mesenteric Cyst, a Rare Cause of Surgical Abdominal Pain: Case Report and Review of the Literature

A lymphatic mesenteric cyst (LMC) is a rare clinical entity, of unclear etiopathogenesis, which can arise in the abdominal cavity or retroperitoneum without a clear origin.

We describe a case of a 74-year-old male presenting with abdominal pain that was non-specific and non-responsive to medical therapy. Laboratory tests clinical examination were inconclusive while the abdominal computed tomography (CT) scan showed a cystic lesion of the ileal mesentery. We performed an open surgical excision of the lesion with the resolution of clinical symptoms. The lesion resulted to be an LMC at the histological examination. At the five-year CT scan follow-up, we did not record any recurrences.

LMCs present without specific symptoms and imaging diagnostic techniques, such as ultrasound (US) or CT scan may define its features, location, or size. The preoperative diagnosis remains difficult, which is why the complete surgical excision is the gold standard treatment, aiming to prevent malignant transformation, complications, and recurrences.

Large intra-abdominal mucinous cystic adenoma: is it of ovarian or mesenteric origin

A 54-year-old female presented with a six year history of increasing abdominal swelling and discomfort and two months of intermittent constipation and difficulty with micturition. She was referred from the gynecological service having been investigated for a pelvic pathology without any positive findings. Her medical history was otherwise unremarkable. Physical examination revealed a non-tender intra-abdominal mass extending from epigastrium to the pelvis with a smooth surface. A large intra-abdominal multi-loculated cyst, separate from the ovaries, was seen on imaging. At laparotomy, the cystic tumour was discovered to arise from the mesentery of the terminal ileum and was resected en bloc. Histopathology revealed the tumour to be a benign mucinous cystadenoma, possibly of ovarian origin. This report aims to raise awareness of the difficulty of distinguishing ovarian from extra-ovarian mucinous cystadenomas on histopathological examination alone.

Complete Surgical Enucleation of a Giant Chylous Mesenteric Cyst

Mesenteric cysts are rare benign abdominal tumors, and they can appear anywhere in the mesentery of the gastrointestinal tract, from the duodenum to the rectum. They are generally asymptomatic and may present as an incidental finding. The diagnosis is confirmed by the laparotomy findings and the results of the histopathological examination. Complete surgical (open or laparoscopic) enucleation of the cyst is the treatment of choice. We present a case of a female patient who presented with abdominal pain and a giant palpable abdominal mass. The patient underwent a surgical exploration which showed a giant mesenteric cyst. A complete surgical enucleation of the cyst was successfully performed without the need of bowel resection. The histopathological examination of the cyst was compatible with the diagnosis of chylous mesenteric cyst.

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

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.

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.

Bowel Imaging in Children: Part 1

The bowel is a challenging abdominal organ to image. The main reason is the variable location, convoluted morphology and motility. A variety of bowel disorders such as congenital, developmental, inflammatory, infectious and neoplastic lesions can affect children and most of them are either unique to this age group or have a distinct clinico-radiological appearance compared to adults. Imaging plays a very important role in characterizing these lesions and further guiding the management. This is the first part of the series on imaging of bowel disorders in children. This article will cover the imaging modalities used for the evaluation of bowel and the imaging features of congenital /developmental disorders.

Giant Mesenteric Cyst and Right Sided Syndrome in a 15-Year-Old Boy

Giant mesenteric cyst is a rare benign abdominal tumor. It usually arises from the mesenteric side of the small bowel. Right side syndrome is the term used for congenital absence of right kidney and right testis. We report on a 15-year-old male who presented with progressive abdominal distension, early satiety, and difficulty walking or running. Abdominal ultrasound and computed tomography (CT) revealed a giant mesenteric cyst, absence of the right kidney, and left moderate hydronephrosis. After excision of the cyst, the patient was fully recovered. Our report shows that both conditions may occur in the same patient and therefore an association of these two diseases cannot be excluded.

Giant mesenteric cyst from the small bowel mesentery in a young adult patient

Mesenteric cysts are rare tumors, they can emerge from any part of the mesentery of the bowel from the duodenum to the rectum. Their symptomatology can mimic almost any abdominal disease making diagnosis troublesome. In some circumstances, these cysts can grow to considerable sizes making resection almost impossible since its size can compromise different structures. Surgery is the treatment of choice as complete resection is the only curative treatment. We present a case of a female patient, she suffered from recurrent episodes of abdominal pain mistaken as gastritis. After a profound evaluation, a giant mass in her abdomen was identified and successfully treated. Giant primary mesenteric cyst was the final diagnosis.

Laparoscopic Treatment of a Retroduodenopancreatic Endometriotic Cyst Observed Postpartum

Endometriosis occurs in 5%-10% of fertile women, usually in the pelvic region, such as the ovaries, uterine ligaments, pelvic peritoneum, and rectovaginal septum. A mesenteric endometriotic cyst is an exceptional observation and difficult to diagnose preoperatively. We report a case of a large mesenteric endometriotic cyst treated by laparoscopy. A 21-year-old Caucasian woman was admitted as an emergency to our Academic Hospital on the 30th day postpartum for abdominal pain and a palpable epigastric mass. A CT scan revealed a mass measuring 7.5 × 5.5 cm showing a fluid content, located below the pancreas. A preoperative diagnosis of mesenteric cyst was made and confirmed by MRI. A dissection of the mass from the inferior vena cava, pancreas, and duodenum was achieved by a laparoscopic approach. During the blunt dissection, avoiding any spillage, the cyst was aspirated to preserve a safe cleavage plane with the lower third of the duodenum showing tenacious adhesions to the mass. Histology revealed an endometriotic cyst of the mesenterium. To our knowledge, this is the first case reported in the literature of laparoscopic treatment of a retroduodenopancreatic endometriotic cyst observed postpartum. In dedicated centers, laparoscopic management could be the gold standard.