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.

1. Mesenteric Cysts
By:
Mohamed Tag El-din Mohamed
Resident of General Surgery
Sohag university hospital

2. Introduction
A mesenteric cyst is formed of fluid
collection between the 2 layers of
small bowel mesentery

3. 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)

4. 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)

5. 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)

6. Types and Etiology
1)False mesenteric cyst:
• Blood cyst due to trauma.
• Tuberculous mesenteric cold
abscess due to caseating
tuberculous mesenteric adentitis.

7. 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)

8. Large mesenteric cyst arising from the small-
bowel mesentery.

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

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

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

12. Presentation
• Mesenteric cysts mostly discovered incidentally
• Symptoms
– Abdominal distention
– vague abdominal pain
– Mass may be palpable .
(Lockhart C et al, 2005)

13. 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)

14. 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)

15. 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)

16. 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)

17. Treatment
A.Medical Therapy
Anti-tuberculous drugs in case of ceasating
tuberculous mesenteric cysts

18. Treatment (conc.)
B.Surgical Treatment
1. Enucleation: The preferred treatment of
mesenteric cysts.
(Hebra A et al, 1993)

19. 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.

20. 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)

21. 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)

22. Treatment (conc.)
• Ultrasound-guided drainage has also
reported to be successful.
(Ma A et al, 2012).

23. 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.

24. 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)

25. 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)

26. 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)