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  • • Rare developmental lesions thought to result from the sequestration of lymphatic tissue during development

    • Characterized by thin walls lined with endothelial cells without surrounding smooth muscle

    • Lesions located in the mesentery, omentum, or retroperitoneum

    • Cysts may be filled with serous lymphatic fluid (common in the mesocolon and omentum), or chyle (common in the small bowel mesentery)

    • Most lesions are benign

    • Cysts often become extraordinarily large before producing symptoms

    • Bleeding, rupture, torsion, and infection of the cyst may occur

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Epidemiology

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  • • Mesenteric cysts twice as common as omental cysts

    • 33% of lesions are detected in children, the remainder in adults

    • Symptomatic cysts are usually diagnosed in children before age 10

    • Commonly discovered incidentally on imaging study obtained for other reasons

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Symptoms and Signs

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  • • Soft, mobile abdominal mass

    • Chronic abdominal pain

    • Acute abdomen

    • Obstructive symptoms

    • -Nausea

      -Vomiting

      -Abdominal distention

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Imaging Findings

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  • Abdominal x-ray: May demonstrate displacement of the viscera by the cyst

    • Contrast study may help differentiate between an intestinal duplication and a mesenteric or omental cyst

    US: Demonstrates a thin-walled hypoechoic homogenous mass that may be uniloculated or multiloculated

    CT scan: Demonstrates a thin-walled fluid density mass that may be uniloculated or multiloculated

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  • • Pancreatic pseudocysts

    • Enteric duplication

    • Echinococcal cysts

    • Inflammatory cysts

    • Retroperitoneal tumors

    • Tumor metastasis

    • Abscess (especially from perforated appendicitis)

    • Large ovarian cysts

    • Localized fluid collection

    • Hematoma

    • Biloma

    • Urinoma

    • Ascites

    • Mesenteric lipodystrophy

    • Primary peritoneal mesothelioma

    • Pseudomyxoma peritonei

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Rule Out

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  • • Abscess

    • Primary or metastatic neoplasm

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  • • Thorough history assessing for abdominal trauma, symptoms and risk factors for pancreatitis (alcoholism, cholelithiasis) or constitutional symptoms (such as weight loss and fatigue)

    • CBC

    • Basic chemistries

    • Amylase and lipase

    • UA

    • Abdominal pelvic CT scan with IV and PO contrast

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When to Admit

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  • • Acute complications only

    • Asymptomatic cyst can be managed as outpatient

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When to Refer

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  • • Children best managed operatively by a pediatric surgeon

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  • • Simple excision of the cyst without resection of adjacent organs or major neurovascular structures

    • Partial excision with marsupialization alternative when complete excision not possible

    • Internal intestinal drainage also an option, particularly if cyst is adjacent to the intestinal wall and there is concern that the cyst may actually be an enteric duplication

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Surgery

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Indications

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  • • Definitive diagnosis and treatment

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Contraindications

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  • • Patients medically unfit for operation

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Treatment Monitoring

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  • • Abdominal exam for mass redevelopment

    • Consider US screening for patients in which entire cyst not removed and thus higher chance ...

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