mesentericcysts
TRANSCRIPT
Mesenteric Cysts
By:
Mohamed Tag El-din MohamedResident of General Surgery
Sohag university hospital
Introduction
A mesenteric cyst is formed of fluid
collection between the 2 layers of
small bowel mesentery
Introduction (conc.)
• Mesenteric cysts can be simple or multiple,
unilocular or multilocular, and they may
contain hemorrhagic, serous, chylous, or
infected fluid.
(Egozi et al, 1997)
Introduction (conc.)
• The fluid is serous in ileal and colonic cysts and
is chylous in jejunal cysts.
• They can range in size from a few millimeters to
40 cm in diameter.
(Egozi EI et al, 1997)
Incidence
• Mesenteric cyst is one of the rarest abdominal
masses.
• The incidence varies from 1 per 100,000 to 1 per
250,000 admissions
• Approximately one third of cases are diagnosed
before the age of 15.(Egozi EI et al, 1997)
Types and Etiology
1)False mesenteric cyst:• Blood cyst due to trauma.• Tuberculous mesenteric cold
abscess due to caseating tuberculous mesenteric adentitis.
2) True mesenteric cyst:• Chylolymphatic cyst “the commonest” due to:
– benign proliferations of ectopic lymphatics . (Bliss DP Jr et al, 1997)
– Obstructed lymphatic drainage.
• Enterogenous cyst due to:– failure of the leaves of the mesentery to fuse.– Sequestrated intestinal epithelium or from duplicated
intestine.
• Treatomatous dermoid cyst• Hydatid cyst
( kasr el-aini introduction to surgery, 8th edition, 2014)
Large mesenteric cyst arising from the small-
bowel mesentery.
Multiple mesenteric cysts, some filled with chyle, arising from the jejunal mesentery.
Huge mesenteric cyst arising from the transverse colon mesentery .
Multiple jejunal mesenteric cysts surrounding a loop of jejunum.
Presentation
• Mesenteric cysts mostly discovered incidentally
• Symptoms
– Abdominal distention
– vague abdominal pain
– Mass may be palpable .
(Lockhart C et al, 2005)
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 or infarction.(Kosir MA et al, 1991)
Investigations
Ultrasonography
• Ultrasonography reveals
fluid-filled cystic structures,
commonly with thin internal
septi and sometimes with
internal echoes from debris,
hemorrhage, or infection.(Wootton-Gorges SL et al,
2005)
Investigations (conc.)
CT scanning
• Abdominal CT scanning adds minimal
information, onlt ti ensure that cyst not
arising from another organ such as the kidney,
pancreas, or ovary.(Nakano T et al, 2007)
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.
(Wootton-Gorges SL et al, 2005)
Treatment
A.Medical Therapy
Anti-tuberculous drugs in case of ceasating tuberculous mesenteric cysts
Treatment (conc.)
B.Surgical Treatment
1. Enucleation: The preferred treatment of
mesenteric cysts.(Hebra A et al, 1993)
Treatment (conc.)
2. Excision and intestinal resection:– is frequently required to ensure that the
remaining bowel is viable.– Bowel resection may be required in 50-60%
of children with mesenteric cysts, whereas resection is necessary in about 30% of adults.
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
the mesentery
• the cyst lining should be sclerosed with 10% glucose solution,
electrocautery, or tincture of iodine to minimize recurrence.
(Ricketts RR, Pediatric Surgery. 5th ed. 1998)
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.
(Bhandarwar AH et al, 2013)
Treatment (conc.)
• Ultrasound-guided drainage has also
reported to be successful.
(Ma A et al, 2012).
Postoperative
• Depend on the intraoperative decision
• If enculation done: the patient is maintained
nothing by mouth (NPO) with intravenous fluids
until bowel function returns(mostly 24 hours).
• If intestinal resection done: follow up until
anastmosis is good.
Follow-up
• Routine postoperative follow-up care 2-3 weeks after discharge
from the hospital is indicated.
• The child's family should be warned about the potential for
intestinal obstruction from adhesions.
• If the patient was treated with marsupialization, closer follow-up
for possible recurrence should be instituted.
• Otherwise, long-term results for simple excision are favorable.
(Chang TS et al, 2011)
Outcome and Prognosis
• Overall results are favorable. The recurrence rate ranges
from 0-13.6%.
• Most recurrences occur in patients with retroperitoneal
cysts or those who had only a partial excision.
• Essentially, no mortality is associated with mesenteric cyst ;
only one pediatric death has been reported since 1950.
(Wong SW et al, 1998)
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 and volvulus.
(Polat C et al, 2004)