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mesenteric cyst
- 2. Introduction A mesenteric cystis formed of fluid collection between the 2 layers of small bowel mesentery.
- 3. Incidence • Mesenteric cyst is one of the rarest abdominal masses. • Theincidence varies from 1 per 100,000 to 1 per 250,000 admissions • Approximately one third of casesare diagnosed before the ageof 15.
- 4. Typesand Etiology 1.Chylolymphatic cyst 2.Enterogenous cyst. 3.Dermoid cyst. 4. Cysts of Urogenital remnant.
- 5. Chylolymphatic cyst: 1.Most common type of mesenteric cyst 2.It occurs due to congenitally misplaced lymphatic tissue that has no efferent communication with the lymphatic system. 3.Content is lymph/chyle,unilocular 4.It has independent blood supply. 5.Treatment is enucleation.
- 6. • Enterogenous cyst due to: 1.failure of the leaves of the mesentery to fuse.Sequestrated intestinal epithelium or fromduplicated intestine. 2.Thick wall lined by mucous membrane. 3.Content is mucinous, 4.It shares blood supply with adjacent intestine wall, 5.Treatment is resection and anastomosis.
- 7. Largemesenteric cyst arising from the small- bowel mesentery.
- 8. Multiple mesenteric cysts, some filled with chyle, arising from the jejunal mesentery.
- 9. Hugemesenteric cyst arising from the transverse colonmesentery.
- 10. Multiple jejunal mesentericcysts surrounding aloop of jejunum.
- 11. Presentation • Mesenteric cysts mostly discoveredincidentally • Symptoms – Abdominal distention – vague abdominal pain – Massmay be palpable .
- 12. Presentation(conc.) • Approximately 10% of patients with mesenteric cysts present with an acute abdominal emergency, the most common picture is small- bowel obstruction, which may be associated with intestinal volvulus orinfarction.
- 13. Investigations Ultrasonography • Ultrasonography reveals fluid-filled cystic structures, commonly with thininternal septi and sometimes with internal echoes from debris, hemorrhage, or infection.
- 14. Investigations (conc.) CTscanning • Abdominal information, CT scanning onlt ti ensure adds minimal that cyst not arising from another organ suchasthe kidney, pancreas, or ovary.
- 15. Investigations (conc.) Radiography(rare) • Plain abdominal radiography may reveal a gasless, homogeneous, water-dense mass that displaces bowel loops laterally or anteriorly in the presence of a mesenteric cyst. Fine calcifications can sometimes be observed within the cyst wall.
- 16. Treatment (conc.) B.SurgicalTreatment 1. Enucleation: Thepreferred treatment of mesenteric cysts of chylolymphatic origin.
- 17. Treatment (conc.) 2. Excision and intestinal resection: –is frequently required to ensure thatthe remaining bowel isviable. –Bowel resection may be required in 50-60% of children with mesenteric cysts, whereas resection is necessary in about 30%of adults.
- 18. Treatment (conc.) 3. partial excision with marsupialization: • If enucleation or resection is not possible because of the size of the cyst or because of its location deep within the root of themesentery • the cyst lining should be sclerosed with 10% glucose solution, electrocautery, or tincture of iodine to minimize recurrence.
- 19. Treatment (conc.) 4. Current apporaches • Laparoscopic management: could be used to localize the cysts, and resection could be performed through a small laparotomy or via an extended umbilical incision.
- 20. Treatment (conc.) • Ultrasound-guided drainage hasalso reported to besuccessful.
- 21. Postoperative • Depend on the intraoperativedecision • If enculation done: the patient is maintained nothing by mouth (NPO) with intravenous fluids until bowel function returns(mostly 24hours). • If intestinal resection done: follow up until anastmosis is good.
- 22. Follow-up • Routine postoperative follow-up care 2-3 weeks after discharge from the hospital isindicated. • Thechild's family should be warned about the potential for intestinal obstruction fromadhesions. • If the patient wastreated with marsupialization, closerfollow- up for possible recurrence should beinstituted. • Otherwise, long-term results for simple excision arefavorable.
- 23. Outcome and Prognosis • Overall results are favorable. Therecurrence rate ranges from 0-13.6%. • Most recurrences occur in patients withretroperitoneal cystsor those who had only apartialexcision. • Essentially, no mortality is associated with mesenteric cyst; only one pediatric death hasbeen reported since1950. (WongSWet al,1998)
- 24. Future • With the widespread use of ultrasonography, mesenteric cysts are being diagnosed earlier, so intervention during early infancy is indicated to prevent potential complications such as intestinal obstruction andvolvulus.