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Lucandri G, Fiori G, Lucchese S, Genualdo F, Pende V, Farina M, Mazzocchi P, Santoro E. Hybrid sequential treatment of a giant serous mesenteric cyst: description of a case and review of the literature. J Surg Case Rep 2022; 2022:rjac397. [PMID: 36101714 PMCID: PMC9464070 DOI: 10.1093/jscr/rjac397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Mesenteric cysts are uncommon benign abdominal tumors that may extend from the root of the mesenteric layers of the gastrointestinal tract into the retroperitoneum or the peritoneal cavity; they are usually asymptomatic and often represent an occasional finding. Definitive diagnosis is confirmed by the surgical intraoperative view and by histopathological examination. Surgical excision of the cyst is the treatment of choice. We present a case of a female patient who presented with back pain and a palpable abdominal mass. Due to large size of the mass and its contiguity with midline, patient underwent an hybrid combined surgical technique, with a first open phase followed by a laparoscopic excision. Complete surgical removal of the cyst was successfully performed without bowel resection, intraoperative spillage of cystic content and without morbidity. Histopathology confirmed diagnosis of simple mesenteric cyst. We strongly recommend a combined approach whenever a large intraperitoneal benign cystic lesion has been diagnosed.
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Affiliation(s)
- Giorgio Lucandri
- Correspondence address. Department of Surgery, San Giovanni-Addolorata Hospital, Via dell’Amba Aradam 9, Rome 00184, Italy. E-mail:
| | - Giulia Fiori
- Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Sara Lucchese
- Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Flaminia Genualdo
- Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Vito Pende
- Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Massimo Farina
- Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Paolo Mazzocchi
- Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Emanuele Santoro
- Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
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2
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Eke C, Greenberg I, Kedia P. Not Your Typical Cyst: A Periduodenal Chylous Cyst Diagnosed via Endoscopic Ultrasound. Cureus 2022; 14:e27284. [PMID: 36039205 PMCID: PMC9403218 DOI: 10.7759/cureus.27284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Chylous mesenteric cysts represent a subgroup of uncommon, mostly benign intra-abdominal masses often identified incidentally on radiographs. Diagnosis is often challenging because these lesions cannot be reliably distinguished from hematomas or other cystic lesions without direct tissue sampling. In addition, data remains scarce regarding nonsurgical diagnostic and therapeutic options for these cysts. This case describes an endoscopic option for a uniquely located chylous cyst.
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3
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Ghielmetti M, Neuschütz KJ, Hirschmann A, Marston K, Steinemann DC, von Strauss und Torney M. Idiopathic lymphatic mesenteric cyst of the proximal jejunum: A case report of an unusual clinical presentation. Int J Surg Case Rep 2022; 97:107402. [PMID: 35870215 PMCID: PMC9403078 DOI: 10.1016/j.ijscr.2022.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Michele Ghielmetti
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Kerstin J. Neuschütz
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | | | | | - Daniel C. Steinemann
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Marco von Strauss und Torney
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland,Corresponding author at: Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
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4
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Sabounji SM, Fall M, Gueye D, Seye C, Ngom G. Acute appendicitis revealing a giant mesenteric pseudocyst: case report. Pan Afr Med J 2022; 41:178. [PMID: 35573424 PMCID: PMC9074052 DOI: 10.11604/pamj.2022.41.178.32577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022] Open
Abstract
Mesenteric pseuodycst is a very rare benign childhood tumor, accounting for less than 1 out of 250,000 hospital admissions. We here report a case of giant mesenteric pseudocyst incidentally detected in a 11-year-old boy with acute appendicitis. He complained of persistent abdominal pain for the past 48 hours. He had a history of intermittent pain for several months. Physical examination showed fever and abdominal pain. Ultrasonography showed large peritoneal fluid related to peritonitis probably of appendicular origin. The patient underwent exploratory laparotomy revealing giant abdominal mesenteric cyst and acute appendicitis. Open resection of the cyst and appendectomy were performed. The diagnosis of uncomplicated acute appendicitis associated with mesenteric pseudocyst was made. Preoperative diagnosis of pseudomesenteric cysts is a clinical challenge. Knowledge is essential and suspicion should be maintained in patients with nonspecific symptoms.
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Affiliation(s)
- Salsabil Mohamed Sabounji
- Cheikh Anta Diop University, Dakar, Senegal,,Pediatric Surgery Department, Heinrich Lübke Regional Hospital, Diourbel, Senegal,,Corresponding author: Salsabil Mohamed Sabounji, Cheikh Anta Diop University, Dakar, Senegal, Pediatric Surgery Department, Heinrich Lübke Regional Hospital, Diourbel, Senegal.
| | - Mbaye Fall
- Cheikh Anta Diop University, Dakar, Senegal,,Pediatric Surgery Department, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Doudou Gueye
- Cheikh Anta Diop University, Dakar, Senegal,,Pediatric Surgery Department, Albert Royer Children´s Hospital, Dakar, Senegal
| | - Cheikh Seye
- Pediatric Surgery Department, Heinrich Lübke Regional Hospital, Diourbel, Senegal,,Alioune Diop University of Bambey, Diourbel, Senegal
| | - Gabriel Ngom
- Cheikh Anta Diop University, Dakar, Senegal,,Pediatric Surgery Department, Albert Royer Children´s Hospital, Dakar, Senegal
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5
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Chylous content might determine the optimal surgical approach for mesenteric lymphatic malformations in childhood. J Vasc Surg Venous Lymphat Disord 2021; 10:430-435. [PMID: 34171533 DOI: 10.1016/j.jvsv.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mesenteric lymphatic malformations (LMs) represent rare congenital anomalies that can include chylous or nonchylous content. The pathologic mechanisms explaining this phenomenon are poorly understood and not yet described. Furthermore, the current management approach does not consider the contents of the mesenteric LMs. In the present study, we have defined the relationship between the lymphatic mesenteric cyst content and the histologic evidence of LMs within the bowel wall. METHODS We retrospectively investigated all patients with mesenteric LMs treated surgically at our department from 1999 to 2018. RESULTS A total of 11 patients (6 girls and 5 boys) were included in our analysis. Seven patients had presented with LMs located in the jejunal mesentery, three in the ileocecal region, and only one in the mesocolon transversum and omentum. Of the 11 children, 7 had had LMs with nonchylous content and 4 had presented with chylous content LMs. Intestinal resection was performed in all 4 patients with chylous content LMs and 4 patients with nonchylous content LMs. Histopathologic evaluation of the surgical specimens determined that only the LMs with chylous content displayed malformed lymphatic channels throughout the bowel wall. The resected small bowel of four patients with nonchylous content showed no LM extension throughout the intestinal wall. CONCLUSIONS LMs with chylous content seem to develop from malformed lymphatic channels within the bowel wall. In such cases, segmental intestinal resection is mandatory. In contrast, mesenteric LMs with nonchylous content can potentially be treated without bowel resection if the blood supply can be preserved. This finding is, to the best of our knowledge, reported in the present study for the first time.
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6
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Salatto A, Indrio F, Campanella V, Curci M, Maggipinto C, Cocomazzi R, Canale F, Nobili M, Bartoli F. A Rare Case of Mesenteric Chylous Cyst in Infant: Case Report and Review of Literature. Front Surg 2021; 8:666488. [PMID: 34195222 PMCID: PMC8236529 DOI: 10.3389/fsurg.2021.666488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
The occurrence of a mesenteric cyst (MC) is common in adults while in children and in infants is rare. In adults mesenteric cysts are often asymptomatic and discovered incidentally; however, in children they commonly present with symptoms of abdominal pain or distension with fever and leucocytosis. We report on a rare case, in our experience, of Mesenteric Chylous cyst (MCC) in an infant with signs and symptoms of intestinal obstruction. Discussion of literature is also reported.
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Affiliation(s)
- Alessia Salatto
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Vittoria Campanella
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Marina Curci
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Cosetta Maggipinto
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Raffaella Cocomazzi
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Francesco Canale
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Maria Nobili
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Fabio Bartoli
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
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7
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Ayas MF, Affas S, Hoilat GJ, Kassab I, Barawi M. A Case of A Mesenteric Cyst Mimicking a Biloma. Gastroenterology Res 2021; 13:279-282. [PMID: 33447307 PMCID: PMC7781273 DOI: 10.14740/gr1336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
| | - Saif Affas
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA
| | - Gilles Jadd Hoilat
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ihab Kassab
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, MI, USA
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8
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Cudia B, D'Orazio B, Calì D, Di Vita G, Geraci G. Lymphatic Mesenteric Cyst, a Rare Cause of Surgical Abdominal Pain: Case Report and Review of the Literature. Cureus 2020; 12:e11766. [PMID: 33409014 PMCID: PMC7779134 DOI: 10.7759/cureus.11766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Bianca Cudia
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ITA
| | - Beatrice D'Orazio
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ITA
| | - Dario Calì
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ITA
| | - Gaetano Di Vita
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ITA
| | - Girolamo Geraci
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, ITA
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9
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Abstract
Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.
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10
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Carvalho NMND, Lopes Filho JA, Plens ICM, Camara VA, Teixeira CCDG, Figueiredo PHD, Araujo Junior OND. Mesenteric cyst presenting with acute abdomen pain and bowel obstruction: Case report and brief literature review. Ann Med Surg (Lond) 2020; 58:134-137. [PMID: 32983433 PMCID: PMC7493041 DOI: 10.1016/j.amsu.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 02/03/2023] Open
Abstract
Mesenteric cysts were first described in 1507 and since then remain as a rare intraabdominal pathology. The etiology of this kind of tumor is still unclear and the classification remains controversial. They are usually asymptomatic, but can also cause acute abdominal pain and sometimes need emergency surgical approach. Clinical history, physical exam and complementary tests do not always provide diagnosis, which in many cases is made after surgery. Surgical management with complete excision of the cyst is the gold standard treatment. Laparoscopy technique should be preferred whenever is possible. The knowledge of these rare tumors is important for considering the correct approach. The goals of this article is to describe a case report of mesenteric cyst presented with acute abdominal pain at the emergency and do a brief literature review about this entity. Mesenteric cysts are a rare cause of intraabdominal mass. Mesenteric cyst should always be considered it whenever the patient has an intraabdominal palpable mass. Computed tomography of the abdomen can help find the diagnosis in many cases. Even when mesenteric cyst is diagnosed incidentally, surgery should always be indicated in order to prevent complications. Surgery is the treatment of choice and recurrence rate is low when the correct treatment is performed.
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11
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A Case Report of a Huge Mesenteric Cyst in a 5-Year-Old Girl: A Rare and Challenging Finding in Radiological Assessment. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2020; 4:e31. [PMID: 32322799 PMCID: PMC7163255 DOI: 10.22114/ajem.v0i0.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Mesenteric cysts are rare benign intra-abdominal vesicles with various clinical presentations. They almost located in the mesentery of the small intestine. The selective therapeutic method is complete surgical excision, however more than half need resection and bowel anastomosis. Case presentation Here, we presented a 5-year-old girl with a huge mesenteric cyst (15×14cm2) mesenteric cyst that was excised surgically., which the diagnosis confirmed by computed tomography scan and managed through surgical excision. Conclusion Acute abdominal pain may be due to the presence of mesenteric cysts, but it is not always possible to differentiate and diagnose it preoperatively, and this challenge especially exists in the case of bulky masses. it is recommended to choose primary radical, surgical treatment in case of intra-abdominal cystic mass in the pediatric age.
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12
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Turner GA, Sharma PV, Waller HM. Chylous cyst of the mesentery: an unexpected diagnosis for an abdominal mass. ANZ J Surg 2020; 90:E110-E111. [PMID: 32227610 DOI: 10.1111/ans.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Greg A Turner
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Prashant V Sharma
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Hayley M Waller
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
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13
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Complete Surgical Enucleation of a Giant Chylous Mesenteric Cyst. Case Rep Surg 2020; 2020:4279345. [PMID: 32257496 PMCID: PMC7104311 DOI: 10.1155/2020/4279345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
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.
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14
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Shabana A, Dholoo F, Nunn R, Hameed W. Case-report: A rare cause of an intra-abdominal mass. Int J Surg Case Rep 2020; 67:278-281. [PMID: 32089471 DOI: 10.1016/j.ijscr.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Amanda Shabana
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Surrey, UK
| | - Farzan Dholoo
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK.
| | - Rebecca Nunn
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK
| | - Waseem Hameed
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK
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15
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Shabana A, Dholoo F, Nunn R, Hameed W. Case-report: A rare cause of an intra-abdominal mass. Int J Surg Case Rep 2019; 65:329-332. [PMID: 31783232 PMCID: PMC6889249 DOI: 10.1016/j.ijscr.2019.10.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022] Open
Abstract
Mesenteric cysts may present with symptoms of early saiety and bloating. Mesenteric cyst anatomy may be difficult to delineate on Ultrasound imaging alone. 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.
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Affiliation(s)
- Amanda Shabana
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Surrey, UK
| | - Farzan Dholoo
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK.
| | - Rebecca Nunn
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK
| | - Waseem Hameed
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK
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