Mesenteric cyst in the descending colon: a case report

Mesenteric cysts are rare abdominal findings. The majority are asymptomatic and if found are discovered incidentally during ultrasonography and/or CT scanning. The optimal surgical treatment requires complete excision of the cyst. We report a case of 36-year-old woman with mesenteric cyst in the descending colon. Laboratory tests indicated no abnormality. Abdominal CT revealed a cystic mass in the retropreritneal space measuring 14.0 x 8.3 x 9.4 cm, density 26-29 HU. We found a cystic mass at the mesentery of the descending colon that was removed in toto. The authors discuss the symptoms and complications, classification, and treatment of mesenteric cysts with review of literature.     

MESENTERIC CYST

Mesenteric cyst is one of the rarest abdominal tumours, with approximately 820 cases reported since 1507. The incidence varies from 1 per 100000 to 250000 admissions. The lack of characteristic clinical features and radiological signs may present great diagnostic difficulties. The cyst may present in one of three ways: (i) non-specific abdominal features; (ii) an incidental finding; or (iii) an acute abdomen. Abdominal pain is the major presenting symptom. Abdominal mass is found in more than 50% of cases and 40% of cases are discovered incidentally. More than one aetiological mechanism is probably involved in the development of mesenteric cysts. Mesenteric cysts have been reported from the duodenum to the rectal mesentery but are most commonly located in the ileal mesentery. Malignant cysts occur in less than 3% of cases. Enucleation of the cyst is the treatment of choice. Knowledge of these tumours is important due to the various complications associated with suboptimal surgical management. Two cases of mesenteric cysts are presented including a recurrent mesenteric cyst in a post-partum woman demonstrating the inferior technique of internal marsupialization. The association of mesenteric cyst with pregnancy is discussed.     

Strangulated Umbilical Hernia Including a Mesenteric Cyst: a Rare Cause of Acute Abdomen

Mesenteric cysts are rare intra-abdominal lesions. They are usually diagnosed as an incidental laparotomy finding in adults but in childhood, they may present with acute abdomen.

In this report, a 72-year old female was referred to our hospital, suffering from acute abdominal pain, several episodes of nausea and vomiting. Clinical abdominal examination revealed an irreducible recurrent umbilical hernia. The patient had both muscular defense and abdominal tenderness. Plain abdominal radiography showed multiple air-fluid levels. With these findings, a diagnosis of acute abdominal pathology was accepted and an urgent laparotomy was performed. A 5-cm-diameter mesenteric cyst was excised from the mesentery of the proximal jejunum and a prosthetic mesh was placed for incisional hernia. This is the first report of a strangulated umbilical hernia complicated with a mesenteric cyst.     

Strangulated umbilical hernia including a mesenteric cyst: a rare cause of acute abdomen

Mesenteric cysts are rare intra-abdominal lesions. They are usually diagnosed as an incidental laparotomy finding in adults but in childhood, they may present with acute abdomen. In this report, a 72-year old female was referred to our hospital, suffering from acute abdominal pain, several episodes of nausea and vomiting. Clinical abdominal examination revealed an irreducible recurrent umbilical hernia. The patient had both muscular defense and abdominal tenderness. Plain abdominal radiography showed multiple air-fluid levels. With these findings, a diagnosis of acute abdominal pathology was accepted and an urgent laparotomy was performed. A 5-cm-diameter mesenteric cyst was excised from the mesentery of the proximal jejunum and a prosthetic mesh was placed for incisional hernia. This is the first report of a strangulated umbilical hernia complicated with a mesenteric cyst.     

Successful laparoscopic removal of mesenteric and omental cysts in toddlers: 3 cases with a literature review

Mesenteric and omental cysts are rare benign intraabdominal anomalies with uncertain etiologies. Surgical removal is the preferred treatment owing to complications related to cyst enlargement. A 1-year-old boy with an intrauterine diagnosis of a cystic mass adjacent to his stomach and liver, a 3-year-old girl, and a 3-year-old boy with an incidental diagnosis of intraabdominal cysts were scheduled for laparoscopic surgery. The mass of the 1-year-old boy was a multiloculated cyst originating from the lesser omentum, the incidental mass in the girl was a multiseptated cyst located in the jejunoileal mesentery, and the incidental mass of the 3-year-old boy was a uniloculated cyst originating from the ileal mesentery. All the cysts were excised either laparoscopically or in a laparoscopy-assisted manner. The laparoscopic or laparoscopy-assisted excision of the mesenteric and omental cysts seems to be a feasible, safe, and cost-effective surgical procedure with shorter operative times, even in toddlers.     

Retroperitoneoscopic excision of a mesenteric cyst

Mesenteric cysts are rare intra-abdominal lesions. We present a case of a mesenteric cyst that was discovered by abdominal computed tomography (CT) and excised by retroperitoneoscopic surgery. There have been 10 reports of excision of mesenteric cysts by laparoscopy in the literature, but retroperitoneoscopic resection of such cysts has not been reported. This case suggests that when a mesenteric cyst arises from the ascending or descending colon, the retroperitoneal approach has a lower risk of traumatizing the bowel than does the laparoscopic intra-abdominal approach, and it does not have to compress other intra-abdominal organs.     

Retroperitoneal, mesenteric, and omental cysts

Retroperitoneal, mesenteric, and omental cysts are rare abdominal tumors occurring in approximately one of 105,000 hospitalized patients. These cysts have a similar pathogenesis that primarily may be ectopic lymphatic tissue. Retroperitoneal and mesenteric cysts can occur anywhere in the area between the duodenum and rectum but are most common in the small-bowel mesentery, especially the ileum. They can appear as chronic abdominal pain, a painless abdominal mass, or acute abdomen. The most common physical finding of a retroperitoneal or mesenteric cyst is a compressible abdominal mass, movable transversely but not longitudinally; omental cysts are freely movable. Diagnostic aids include abdominal computed tomography and ultrasound. The upper gastro-intestinal (GI) tract series, barium enema examination, and intravenous pyelogram exclude GI and genitourinary cysts and tumors. Treatment of choice is enucleation; resection of the adjacent bowel may occasionally be necessary. Morbidity and mortality should be very low because of modern surgical techniques and follow-up procedures.     

Mesenteric cyst neoformation. A case report

Mesenteric cysts are rare lesions, with 1 case per 100,000 hospital admission reported. They have to be differentiated from ovarian cysts, gastrointestinal duplications and desmoid cysts. The symptoms are variable, ranging from asymptomatic cases with incidental discovery to chronic abdominal discomfort and acute abdomen. They are usually correlated to the location and the size of the lesion. Abdominal ultrasonography and computed tomography may lead to a correct diagnosis, which is regularly made at the time of abdominal exploration. Surgery is the treatment of choice, consisting with the removal of the cyst, eventually associated with bowel resection. It has to be radical in order to prevent the recurrence of the disease. A case of mesenteric cyst in a sixty-nine-years-old woman hospitalized for chronic abdominal pain is reported. In this case the cyst has been enucleated from the mesentery with open surgery without the need for bowel resection.     

Large mesenteric cyst mimicking an ovarian cyst in an 8-year-old: A case report

Introduction and importancePediatric mesenteric cysts, rare and usually benign intra-abdominal tumors, are a difficult preoperative diagnosis due to ambiguous clinical characteristics. The final diagnosis is typically established only during surgery or histological analysis.Case presentationAn 8-year-old female presented with five days of worsening abdominal pain, associated with nausea, vomiting, and fever, as well as vague tenderness in the right quadrants on examination. Computed tomography imaging showed a 10.5 × 8.7 × 7 cm abdominal mass, most suspicious for a cystic mass of ovarian origin. Upon diagnostic laparoscopy, a mesenteric cyst extending to the root of the mesentery was visualized and entirely resected after conversion to an exploratory laparotomy. Histopathological examination of both the cystic fluid and specimen suggest a benign mesenteric cyst.Clinical discussionAlthough mesenteric cysts are noticeably rare, it is important differential to consider in pediatric patients with non-specific symptoms like abdominal pain and distention, intestinal obstruction, or a palpable abdominal mass. Notably, these cysts can be managed successfully by complete surgical resection with an excellent outcome.ConclusionThis report recounts an interesting case of a large mesenteric cyst that mimicked an ovarian cyst in a pre-pubertal girl.     

Mesenteric chylous cysts simulating a pelvic disease: a case report

Mesenteric chylous cysts, also known as retroperitoneal chylomatous cysts, mesenteric lymphangiomas or chyloma of the mesentery, are extremely rare and their aspecific clinical presentation can mimic other diseases. In addition, imaging techniques, which are rarely helpful in the correct diagnosis, can demonstrate aspecific features. The Authors report the case of a 62-year-old woman admitted to the hospital for two incidental abdominal masses diagnosed during a yearly monitoring examination and considered to be large adnexal masses. The abdominal masses were removed at laparotomy. Both frozen section and final histopathological examination showed mesenteric chylous cysts. Mesenteric chylous cysts are usually a benign abdominal pathology. As illustrated by this case, even if they are extremely rare, they should be not underrated. The Authors review the literature, confirming the rarity of the disease and defining its characteristics.     

Mesenteric Cyst of the Descending Colon: Report of a Case

Mesenteric cysts are rare benign, lesions that are discovered accidentally or during the management of one of their complications (torsion, rupture, haemorrhage, obstruction of nearby organs). We present the case of a 56-year old female patient, with a mesenteric cyst of the descending colon, discovered accidentally during a routine gynaecological examination. Preoperative evaluation included U/S scan, IVP, CT scan and MRI scan. She underwent exploratory laparotomy and the cyst was enucleated intact. Postoperative period was uneventful and pathological examination showed a benign mesenteric lymphangioma. The patient is free of symptoms on 1-year follow-up. We also review the literature.     

Mesenteric cyst of the descending colon: report of a case

Mesenteric cysts are rare benign, lesions that are discovered accidentally or during the management of one of their complications (torsion, rupture, haemorrhage, obstruction of nearby organs). We present the case of a 56-year old female patient, with a mesenteric cyst of the descending colon, discovered accidentally during a routine gynaecological examination. Preoperative evaluation included U/S scan, IVP, CT scan and MRI scan. She underwent exploratory laparotomy and the cyst was enucleated intact. Postoperative period was uneventful and pathological examination showed a benign mesenteric lymphangioma. The patient is free of symptoms on 1-year follow-up. We also review the literature.     

Role of laparoscopic surgery in treatment of mesenteric cysts

Mesenteric cysts are rare benign intraabdominal lesions without typical clinical findings. Treatment is indicated if they become symptomatic due to enlargement of the cyst. We report 3 patients who were treated by laparoscopic surgery. In 3 patients (3 women, ages 18, 18, 46 years) admitted to our hospital with uncharacteristic abdominal pain, a mesenteric cyst 4.5–18 cm in diameter was diagnosed by ultrasonography and CT scan or MRI. One cyst was partially resected laparoscopically by unroofing of the surface, and the other two were resected completely. There were no intra- or postoperative complications. During follow-up, cyst recurrence was diagnosed in the patient with cyst unroofing 10 months after surgery, and complete cyst resection was successfully performed laparoscopically. Mesenteric cysts can be successfully managed laparoscopically. In order to prevent recurrence, complete resection should be performed. Received: 16 June 1998/Accepted: 12 February 1999     

Mesenteric and retroperitoneal cysts.

Mesenteric and retroperitoneal cysts are rare intra-abdominal tumors. Ten new patients are presented as well as 152 other cases reported in the English literature. These 162 cases were then analyzed for significant trends. Patients under 10 years of age were significantly different from the older group with respect to a shorter duration of symptoms, a higher number of patients requiring an emergency operation, a lower number of recurrences and the location of the cyst. Patients with retroperitoneal cysts were more likely to have incomplete excision of the cyst and therefore had a higher incidence of recurrence. They also required marsupialization more often. Retroperitoneal cysts should be considered a different entity from mesenteric cysts even though they present clinically in a similar fashion. The outcome of surgical treatment is less satisfactory in patients with retroperitoneal cysts.     

Mesenteric cysts. Toward less confusion?

OBJECTIVE: Mesenteric cysts are rare intra-abdominal masses generally omited or briefly reported in textbooks. Their rarity had fostered a lack of information and difficulty in classification. The goal of the study is to present a simple, comprehensive, and reproducible classification of mesenteric cysts. METHODS: A large review of the literature with particular attention to recent series was performed in order to identify and characterize the different groups of mesenteric cysts. RESULTS: Although cysts of lymphatic and mesothelial origin are those most frequently encountered, they were confounded or omitted in previous classifications. However, their distinction is important because their incidence and mode of presentation differ. Lymphangiomas predominate in male children, may cause acute abdominal pain, and frequently require resection of adjacent structures. In contrast, cysts of mesothelial origin such as benign cystic mesothelioma are seen more frequently in young and middle-aged women, usually present with more indolent symptoms, and often recurs. CONCLUSIONS: A new classification based essentially on histopathological features should include the 6 following groups: (1) cysts of lymphatic origin (simple lymphatic cyst and lymphangioma); (2) cysts of mesothelial origin (simple mesothelial cyst, benign cystic mesothelioma, and malignant cystic mesothelioma); (3) cysts of enteric origin (enteric cyst and enteric duplication cyst); (4) cysts of urogenital origin; (5) mature cystic teratoma (dermoid cysts), and (6) pseudocysts (infectious and traumatic cysts).     

Laparoscopic treatment of mesenteric cysts. Report of two cases

Mesenteric cysts are rare intraabdominal tumors. Since the first report by Benevial in 1507, approximately 800 cases of mesenteric cysts have been described in the literature. Clinical presentation is variable and depends on the size and location of the cyst. This lesion are often asymptomatic or can present as an abdominal palpable mass or with abdominal pain, nausea, vomiting, diarrhea or constipation. Laboratory tests are usually helpless. Ultrasonography and CT scan are the best diagnostic tools. In the past the treatment of choice was totally resection performed by open surgery. With the advent of laparoscopic surgery same authors report mesenteric cysts excised laparoscopically. The Authors report two cases of mesenteric cysts that were excised by laparoscopic surgery using. The cysts of both patients were located in the mesenterium of colon. There were no intraoperative of postoperative complications and the postoperative course was uneventful and both patients returned to full activity within a short time. The follow-up period ranged from 6 to 36 months and there were no recurrences. The laparoscopic surgery is a minimally invasive techniques and represent an alternative safe and less invasive operation for these abdominal cysts.     

Mesenteric Cysts: An Institution Experience Over 14 Years and Review of Literature

Background  Mesenteric cysts are rare intra-abdominal lesions and account for only one in 100,000 acute adult admissions. There is a broad spectrum of symptoms and patients present with nonspecific complaints of abdominal pain, distension, or an abdominal mass. In this study, we present a series of patients with mesenteric cysts, with emphasis on the presentation, management, and outcome. Methods  A total of 16 cases presented to our institution from 1994 to 2007. The cases were retrospectively reviewed and information was culled from the case documents. Results  There were nine females and seven males (age range, 12–68 years). The most common presentation was abdominal pain (63%), followed by abdominal mass (44%). Laparoscopic surgical excision of the cyst was performed in 3 (19%) patients, laparotomy in 12 (75%), and 1 patient refused surgery. The size of the cyst ranged from 4 to 29 cm. The cyst originated from the retroperitoneum in five patients, the sigmoid mesocolon in four patients, and small bowel mesentery in four patients. Although most of the cysts were benign, three had foci of malignancy and another had a focus of gastrointestinal stromal tumor. None of the cases recurred during follow-up. Conclusions  Mesenteric cysts have diverse presentation and arise from a variety of sites. They can be successfully managed by complete resection, and laparoscopic excision of the cysts is becoming an increasingly popular option.     

Gastric duplication cyst (gdc) associated with ectopic pancreas: Case report and review of the literature

IntroductionDuplication of the alimentary tract is a relatively rare congenital anomaly. It can affect any part of the gastrointestinal tract, with ileum being the most common site. These malformations are believed to be congenital, formed before the differentiation of epithelial lining, and therefore named for the organ with which they are associated. Duplication cysts of the stomach represent four percent of all alimentary tract duplications.Case reportHere, we report a rare case of symptomatic duplication cyst of stomach associated with ectopic pancreas presenting in adult.DiscussionGastrointestinal duplication is a relatively rare anomaly that may occur at any level from oral cavity to rectum with ileum being the most common site. Duplication cysts of the stomach are quite rare, and most of them have been reported in children. Duplication cysts of ileum are usually located on the mesenteric border, whereas the usual location for gastric duplication cysts is along the greater curvature. The duplication cyst is entirely separated from the adjacent bowel but shares a common wall. Complete removal is the treatment choice to avoid the risk of possible complications such as obstruction, torsion, perforation, hemorrhage, and malignancy. A non-communicating GDC is classically treated by complete excision of the cyst and resection of the shared wall between stomach and the duplication cyst.ConclusionThis unusual developmental anomaly should be included in the differential diagnosis of cystic masses of the gastrointestinal tract, and the possibility of malignancy should also be considered, so as be treated surgically by complete resection.     

An atypical site of a retroperitoneal epidermoid cyst in a middle-aged woman

INTRODUCTIONRetroperitoneal cysts are rare, usually asymptomatic, abdominal lesions. Epidermoid cysts developing in this space usually occur in middle-aged women and are incidentally discovered in the presacral region during ultrasound examination. Occasionally, cysts may arise from splenic tissue or adrenal glands and develop above the presacral area.PRESENTATION OF CASEWe present the unusual location of a cyst in the retroperitoneal space in a 41-year-old woman admitted to hospital due to detection of a lesion in ultrasound imaging. A CT scan confirmed large intra-abdominal cyst. At operation, a large retroperitoneal thin-walled cyst with no evident arising point was discovered. Histologic analysis revealed epidermoid cyst.DISCUSSIONOur patient presented with giant retroperitoneal cyst extending from the subhepatic region to the uterine and bladder. To our knowledge, this unusual location in adult has not been previously reported in the literature. In our case the lesion was adjacent to inferior vena cava and mesenteric vessel which required special attention during preparation and was technically demanding.CONCLUSIONSurgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts. Successful treatment of benign retroperitoneal epidermoid cysts depends on appropriate diagnosis, careful operative technique, and adequate management of the underlying pathology.     

Acute abdomen due to rupture of mesenteric cysts. Observations on a clinical case and review of the literature

Personal experience based on a clinical case of a young woman with acute abdominal pain referable to acute appendicitis is presented. The surgical procedure was performed through a Mc Burney incision and revealed the rupture of mesenteric cysts; removal of the cysts was carried out without intestinal resection. Post-operative course was uneventful and 2 years follow-up showed no recurrence. Mesenteric cysts are an uncommon pathology, mainly in adult ages. After an analysis of the incidence and etiology, the pathological features and types of clinical presentation are discussed. Diagnosis in asymptomatic cases is usually made in search of other diseases. Complications are rare: rupture, infection and intestinal obstruction. In such cases, the clinical presentation is usually attributable to the main causes of acute abdomen, unless ultrasonography or CT scan are performed. When mesenteric cyst is diagnosed, a laparoscopic approach should be performed, even if in emergency traditional surgery is justified. Total excision of the cyst is necessary to avoid recurrence and obtain a correct pathologic evaluation.