mesenteric cyst

types, treatment of cysts,

1. Mesenteric Cysts Dr.V.Veeranadha reddy Assistant professor, General Surgery

2. Introduction A mesenteric cyst is formed of fluid c ollect i o n b e t w een the 2 l a y e r s of small bowel mesentery .

3. Incidence Mes e n t e r ic c y s t i s on e of t h e r a r e s t abdom i nal 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 .

4. Types and 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 from duplicated 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. Large mesenteric cyst arising from the small- bowel mesentery.

8. Multiple mesenteric cysts, some filled with chyle, arising from the jejunal mesentery.

9. Huge mesenteric cyst arising from the transverse colon mesentery.

10. Multiple jejunal mesenteric cysts surrounding a loop of jejunum.

11. Presentation Mesenteric cysts mostly discovered incidentally Symptoms Abdominal distention vague abdominal pain Mass may be palpable .

12. Presentation(conc.) App r o xi m a t e l y 1 % of p a ti e n ts with mese n t e r i c cysts present with an acute abdominal emergency, the most common picture is small- bowel obstruction, which may be associated with intestinal volvulus or infarction .

13. I n v es ti g a tions Ultrasonography Ultrasonography reveals fluid-filled cystic structures, commonly with thin internal septi and sometimes with internal echoes from debris, hemorrhage, or infection .

14. Investigations (conc.) CT scanning Abdominal i n f orm a t i on, CT scanning onlt t i e n su r e a d d s minimal th a t c y s t n ot arising from another organ such as the 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.Surgical Treatment 1. Enucleation: The preferred treatment of mesenteric cysts of chylolymphatic origin.

17. Treatment (conc.) 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.

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 the mesentery 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 has also reported to be successful .

21. P o s t op e r a ti v e 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.

22. F ollow - up Routine postoperative f oll o w - u p c a r e 2 - 3 w e ek s a f t e r 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 .

23. 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)

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 and volvulus .