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Mesenteric cysts in children
M A Chung1, M L Brandt, D St-Vil
1Department of Surgery, Hopital Sainte-Justine, Montreal, Quebec, Canada.
Insights
Mesenteric cysts in children are rare but often symptomatic, frequently mimicking appendicitis. Early diagnosis via ultrasound and complete surgical resection ensure excellent outcomes for pediatric patients.
Area of Science:
- Pediatric Surgery
- Abdominal Imaging
- Gastrointestinal Pathology
Background:
- Mesenteric cysts are uncommon intra-abdominal masses in pediatric patients.
- Presentation can range from asymptomatic to acute abdomen, posing diagnostic challenges.
Observation:
- A study reviewed 15 pediatric cases of mesenteric cysts treated between 1970 and 1990.
- Abdominal pain was the most common presenting symptom.
- Ultrasound accurately diagnosed cystic masses preoperatively in all cases.
Findings:
- Mesenteric cysts were most frequently misdiagnosed as acute appendicitis.
- Complete cyst excision is the preferred surgical approach.
- Recurrence was noted only after cyst drainage, not resection.
Implications:
- Early and accurate diagnosis of pediatric mesenteric cysts is achievable with ultrasonography.
- Complete surgical resection is the gold standard for treatment, leading to favorable outcomes.
- Awareness of mesenteric cysts is crucial to avoid misdiagnosis, particularly of appendicitis.
Abstract:
Mesenteric cysts are rare intraabdominal lesions of childhood that may vary in presentation from an asymptomatic mass to an acute abdomen. From 1970 to 1990, 15 children were diagnosed and treated for mesenteric cysts at Ste Justine Hospital in Montreal. The ages ranged from birth to 18 years (average age, 6 years). There were 9 boys and 6 girls. Ten patients required emergency surgery and five underwent elective surgery. The main presenting symptom was abdominal pain. Ten patients had preoperative ultrasounds that were diagnostic for a cystic mass in all patients. The second most frequent preoperative diagnosis was appendicitis. The cysts were located in the small bowel mesentery in 5 cases, the base of the mesentery with retroperitoneal extension in 4 cases, the transverse mesocolon in 4 cases, and the gastrocolic ligament in 2 cases. Operative procedures performed included complete cyst excision (9 patients), complete excision with intestinal resection (5 patients), and drainage of the cyst (1 patient). The only recurrence in this series occurred after drainage. One other patient had recurrence of a mesenteric cyst following resection performed elsewhere. Mesenteric cysts are rare in children, are usually symptomatic, and are most commonly misdiagnosed as acute appendicitis. Accurate preoperative diagnosis is possible with current ultrasonographic imaging techniques. Complete cyst resection is the procedure of choice and results in an excellent outcome.