A 38-year old woman presented with abdominal pain and was found to have a cystic mass in her upper left abdomen. CT and ultrasound imaging revealed a well-defined hypodense cystic mass measuring 7x6 cm. She underwent open surgery where a cystic lesion was excised from her small intestine mesentery. Histopathology found it to be a simple lymphatic cyst lined with fibrous tissue and lymphoid aggregates. Mesenteric cysts are rare benign lesions of unknown etiology that can cause abdominal pain from compression of nearby structures. Surgical excision is the treatment for symptomatic cysts to avoid complications from rupture or torsion.

1. Mesenteric Cysts
Dr Fatima M Khalid
Post Graduate Trainee
DHQ Rawalpindi

2. Scenario
• A 38 year old woman presented to opd with complain of vague
abdominal pain for 01 week. Examination revealed only a focal
tenderness in left part of her abdomen. Ultrasound revealed anechoic
lesion in her upper left abdomen….

3. CT showed a
well defined
hypodense
cystic mass
almost 7*6 cm.

4. • Open surgery was performed. It revealed a cystic lesion between layers of
small gut mesentery. It was excised within healthy borders and sent for
histopath

5. • It showed a thick fibrous wall, pervaded by lymphoid aggregates, a
definitive inner epithelial lining was not found. The findings were
consistent with a simple lymphatic cyst of a mesentery.

6. • Cysts of mesentery are benign lesions with incidence of less than one in
100, 000. Etiology remains unknown but theories include degeneration of
mesenteric lymphatics or simply arising as a congenital abnormality.
• Cysts could be asymptomatic or cause symptoms of a mass lesion.
• Cysts can cause chronic intermittent abdominal pain secondary to
compression of adjacent structures. It can cause anorexia, nausea,
vomiting, fatigue, even weight loss.
• Acute pain is caused by rupture or torsion or from acute hemorrhage into
cyst
Reference: Schwartz volume 2 page 1324

7. • Examination may reveal a mass lesion that is only mobile from side to
side ( Tillaux’s sign)
• CT, abdominal ultrasound are used to evaluate patients with
mesenteric cysts. They reveal a cystic structure without a solid
component in central abdomen. They are generally unilocular.
• When symptomatic, simple mesenteric cysts are surgically excised
either openly or laparoscopically when feasible. Cyst unroofing or
marsupilization is not recommended, as mesenteric cyst have a high
propensity to recur after drainage alone.
• Reference: Schwartz volume 2 page 1324

8. Types with their treatment
• Mesentery of small intestine (60%) colon (40%)
• 1- chylolymphatic
• Most common variety, probably arising in congenitally misplaced
lymphatic tissue that has no efferent, mostly in mesentery of ileum.
• Since it has a blood supply that is independent from that of adjacent
intestine, and thus enucleation is possible without need for gut
resection
• bailey volume 2 page 983

9. • 2. Enterogenous cyst: to be derived either from diverticulum of
mesenteric border of intestine that has become sequesteredfrom
intestinal canal during embryonic life or from duplication of intestine.
• Thicker than lymphatic cyst, lined by mucous membrane, sometimes
ciliated.
• Since the muscle in wall of enteric duplication cyst and the bowel
with which it is contact have a common blood supply,consequently,
removal of cyst always entails resection of related portion of intestine

10. • 3, Urogenital remnant
• A cyst developing in retroperitoneal space often attains very large
dimensions. Many of these cysts are believed to be derived from a
remnant of the Wolffian duct, in which case they are filled with clear
fluid.

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