• 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
• 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
• 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
• Pancreatic pseudocysts
• Enteric duplication
• Echinococcal cysts
• Inflammatory cysts
• Retroperitoneal tumors
• Tumor metastasis
• Abscess (especially from perforated appendicitis)
• Large ovarian cysts
• Localized fluid collection
• Mesenteric lipodystrophy
• Primary peritoneal mesothelioma
• Pseudomyxoma peritonei
• Thorough history assessing for abdominal trauma, symptoms and risk factors for pancreatitis (alcoholism, cholelithiasis) or constitutional symptoms (such as weight loss and fatigue)
• Basic chemistries
• Amylase and lipase
• Abdominal pelvic CT scan with IV and PO contrast
• 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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