This document discusses mesenteric and omental cysts, which are rare fluid-filled structures caused by blockages in lymphatic drainage. They can occur in the mesentery, which connects the intestines to the body, or the omentum, folds of fatty tissue around the intestines. Symptoms include abdominal pain or distention. Ultrasound and CT scans are used to identify the cysts. Surgical removal is often needed if they cause obstruction or other issues. Enucleation or excision with possible intestinal resection are the main treatment options. Prognosis is generally favorable after surgery.

1. 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

3.  In 1907, the Italian anatomist Benevieni first reported a
mesenteric cyst following an autopsy on an 8-year-old girl.
 In 1842, vonRokitansky 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.

4.  Mesenteric cysts commonly occur in small-bowel mesentery
on mesenteric side of the bowel.
 Can 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.

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.

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

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.
 May be result of dermoid cysts or teratomas.

10.  Chylolymphatic;
 Enterogenous;
 Urogenital remnant (actually retroperitoneal but project into
peritoneum);
 Dermoid.

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

12.  Derived either from a diverticulum of the mesenteric
border of the intestine or from a duplication of the
intestine.
 Content 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.

13.  Developing 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.

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.

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

17.  Malignant transformation of mesenteric cysts has occurred in
adults.
 Malignant 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

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

20. Radiography
Plain abdominal radiography reveal
 Gasless, 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.

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

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.

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.
 Cyst lining should be sclerosed with 10% glucose solution,
electrocautery, or tincture of iodine to minimize recurrence.

25. 4. Current approaches
Laparoscopic management:
 Used to localize the cysts, and resection could be
performed through a small laparotomy or via an extended
umbilical incision.
Ultrasound-guided drainage
 Reported 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.
 Patient treated with marsupialization, closer follow-up for
possible recurrence should be instituted.
 Long-term results for simple excision are favorable.

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.
 No mortality is associated with mesenteric cyst.
 Only one pediatric death has been reported since 1950.