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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
The surgical experience for retroperitoneal, mesenteric and omental cyst in children
So Hyun Nam1, Dae Yeon Kim, Seong Chul Kim
1Department of Pediatric Surgery, Inje University Haeundae Paik Hospital, Busan, Korea.
Insights
Rare intra-abdominal cysts in children, often benign lymphangiomas, can cause acute abdomen. Complete surgical excision is typically successful, leading to favorable outcomes with no recurrence observed.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Abdominal Imaging
Background:
- Intra-abdominal cystic masses originating from the retroperitoneum, mesentery, or omentum are uncommon.
- These rare cysts are predominantly benign but can present as complicated masses encasing vital organs.
Purpose of the Study:
- To analyze the clinical characteristics, histological diagnoses, and surgical outcomes of pediatric patients with retroperitoneal, omental, and mesenteric cysts.
- To evaluate the feasibility and success of surgical management for these rare intra-abdominal cystic lesions.
Main Methods:
- Retrospective analysis of clinical data from children who underwent surgery for retroperitoneal, omental, or mesenteric cysts between 1998 and 2010.
- Review of patient demographics, presenting symptoms, cyst location and size, surgical procedures, histopathological findings, and postoperative outcomes.
Main Results:
- Twenty-three children (12 male, 11 female) with a median age of 46 months underwent surgery.
- The majority of cysts (20/23) were lymphangiomas, with common presentations including abdominal mass, pain, or distension.
- Complete excision was achieved in 20 cysts; 5 mesenteric cysts required bowel resection, and 3 retroperitoneal cysts had incomplete excision due to complexity. One mortality occurred due to sepsis from an extensive cyst.
Conclusions:
- Preoperative diagnosis and precise localization of these rare cysts remain challenging.
- Despite their size and location, complete surgical excision is often feasible and associated with favorable outcomes.
- These cystic masses should be considered in the differential diagnosis of acute abdomen in children.
Purpose:
Intra-abdominal cystic masses originating from the retroperitoneum, mesentery or omentum are very rare and mostly benign tumors, but sometimes present as a complicated cyst encasing the major organs.
Methods:
We analyzed the clinical findings, histologic diagnosis, and surgical outcomes in children who underwent operation for retroperitoneal, omental, and mesenteric cyst from 1998 to 2010, retrospectively.
Results:
Twenty-three patients (male, 12; female, 11) underwent the operation at a median age of 46 months (range, 9 days to 16 years). Among them, 17 cysts presented one or two symptoms such as abdominal mass, abdominal pain or abdominal distension. The median duration of symptoms was 7 days (range, 1 day to 365 days). Five were detected prenatally. Ten cysts were found in retroperitoneum, 8 in the omentum and 5 in the mesentery. The median diameter was 13 cm (range, 3 to 30 cm). Twenty cysts were completely removed. Five mesenteric cysts required bowel resection and anastomosis. Three of retroperitoneal cysts were impossible to complete excise because of location and extensiveness. Pathologically, 20 cysts were lymphangioma and 3 were pseudocyst. The morbidity was one of adhesive ileus and the mortality was one who had extensive retroperitoneal cyst with mesenteric cyst. He died from sepsis. During follow-up period, there was no recurrence.
Conclusion:
Preoperative diagnosis and localization for these cysts are very difficult. Complete excision was possible in almost all cases despite the size, bringing a favorable outcome. The possibility of this disease entity should be considered as the cause of acute abdomen.
