Mesenteric and omental cyst.pptx

MESENTERIC AND OMENTAL CYST

1. Mesenteric and omental cyst Presented by....... DR.JAFOR EKBAL PHASE B RESIDENT(PAEDIATRIC SURGERY) MMCH

2. Rare condition of the mesentery and omentum blockage of lymphatic drainage leading to the formation of fluid filled structures called cysts Mesentery : Double layer of tissue connecting the small intestines to the rest of the body. Omentum : Folding of fatty tissue extending from the stomach and draping over the large and small intestines Definitions

3. In 1907 , the Italian anatomist Benevieni first reported a mesenteric cyst following an autopsy on an 8-year-old girl. In 1842 , v onRokitansky described a chylous mesenteric cyst. Gairdner published the first report of an omental cyst in 1852 . Tillaux performed the first successful surgery for a cystic mass in the mesentery in 1880 . Background

4. Mesenteric cysts commonly occur in small-bowel mesentery on mesenteric side of the bowel. C an shelled out from between the leaves of the mesentery, May require bowel resection to ensure that blood supply to the bowel is not compromised. Omental cysts can removed without resecting the adjacent transverse colon or the stomach.

5. Mesenteric and omental cysts are rare. 1 in every 100,000 adult hospital admissions, while pediatric literature demonstrates an incidence of approximately 1 in every 20,000 admissions. Mesenteric cysts 4.5 times more common than omental cysts . More common in females. Approximately one third of cases are diagnosed before the age of 15. Epidemiology

6. Mesenteric and omental cysts can be Simple Multiple and Unilocular Multilocular They contain hemorrhagic, serous, chylous , or infected fluid. The fluid is serous in ileal and colonic cysts and is chylous in jejunal cysts. Pathological features :

7. Etiologic theories include: Failure of the embryonic lymph channels to join the venous system Failure of the leaves of the mesentery to fuse Trauma Neoplasia Degeneration of lymph nodes Etiology

8. The most common theory proposed by Gross – Benign proliferation of ectopic lymphatics in the mesentery that lack communication with the remainder of the lymphatic system.

9. Mesenteric cysts occur anywhere in the mesentery of the gastrointestinal (GI) tract. extend from the base of the mesentery into the retroperitoneum. most common site are ileal mesentery of the small bowel or the sigmoid mesentery of the colon . Omental cysts are confined to the lesser or greater omentum . M ay be result of dermoid cysts or teratomas .

10. C hylolymphatic ; Enterogenous ; Urogenital remnant (actually retroperitoneal but project into peritoneum ); Dermoid . Classification

11. Chylolymphatic cyst most common variety. A rising in congenitally misplaced lymphatic tissue H as no efferent communication with the lymphatic system. independent blood supply. enucleation is possible without the need for resection of gut.

12. D erived either from a diverticulum of the mesenteric border of the intestine or from a duplication of the intestine. C ontent is mucinous- colourless or yellowish brown as a result of past haemorrhage . common blood supply removal of the cyst always entails resection of the related portion of intestine. Enterogenous cysts

13. D eveloping in the retroperitoneal space. Cyst may be unilocular or multilocular . Many of these cysts are believed derived from a remnant of the Wolffian duct Filled with clear fluid. Urogenital remnant

14. Pathological classification

15. mostly discovered incidentally Children with symptoms have abdominal distention due to enlarging cyst or vague abdominal pain with or without a mass intestinal obstruction or appendicitis. Other symptoms are infection, bleeding , volvulus, ascites and rupture of the cyst. Signs and Symptoms

16. Intestinal obstruction (most common) Volvulus Hemorrhage into the cyst Infection Rupture Cystic torsion Obstruction of the urinary and biliary tract Complications

17. Malignant transformation of mesenteric cysts has occurred in adults. M alignant mesenteric and omental cysts have not been reported in children .

18. Intestinal duplication cyst Ovarian, choledochal , pancreatic, splenic, or renal cysts Hydronephrosis Cystic teratoma Hydatid cyst Ascites differential diagnosis

19. Ultrasonography reveals fluid-filled cystic structures, commonly with thin internal septa and sometimes with internal echoes from debris, hemorrhage or infection. Investigations

20. Radiography Plain abdominal radiography reveal G asless , homogeneous, water-dense mass that displaces bowel loops laterally or anteriorly in the presence of a mesenteric cyst or posteriorly in the presence of an omental cyst . Fine calcifications can sometimes be observed within the cyst wall .

21. Abdominal computed tomography (CT) adds minimal additional information, though it can reveal that the cyst is not arising from another organ such as the kidney, pancreas, or ovary . Radionuclide scanning of the biliary tract excludes choledochal cysts from diagnostic consideration . Other modalities

22. In children with mesenteric or omental cysts, the most common indication for surgical intervention with or without signs of intestinal obstruction. Treatment

23. 1. Enucleation: The preferred treatment of mesenteric cysts . 2. Excision and intestinal resection: – 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 . Surgical Treatment

24. 3. Partial excision with marsupialization: Done 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. C yst lining should be sclerosed with 10% glucose solution , electrocautery, or tincture of iodine to minimize recurrence .

25. 4. Current approaches Laparoscopic management: U sed to localize the cysts, and resection could be performed through a small laparotomy or via an extended umbilical incision . Ultrasound-guided drainage R eported to be successful.

26. Routine postoperative follow-up care 2-3 weeks after discharge from the hospital is indicated. Child's family should be warned for intestinal obstruction from adhesions. P atient treated with marsupialization, closer follow-up for possible recurrence should be instituted. L ong-term results for simple excision are favorable. Follow-up

27. 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. N o mortality is associated with mesenteric cyst. O nly one pediatric death has been reported since 1950. Outcome and Prognosis