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Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain-A case
Thomas Serena1, Raisa Gao1, Kelly Dinnan1
1Beaumont Health Farmington Hills, Department of General Surgery, 28050 Grand River Avenue, Farmington Hills, MI, 48336, USA.
Introduction:
Mesenteric psuedocysts are rare tumors of the gastrointestinal mesentery that are seldom symptomatic. Although these benign tumors are most commonly found incidentally during work-up for other pathology, they can be troublesome in select patients based off size, location and risk of malignant transformation. This case is reported in accordance with SCARE Criteria [1].
Presentation Of Case:
A 24 year-old-male presents with life-long migratory abdominal pain presents with a one week history of acute pain associated with nausea. Computed tomography revealed free fluid in the pelvis and a thin-walled mesenteric cyst within the left, mid-abdominal mesentery measuring approximately 4.3 × 4.0 × 4.0 cm. The patient was admitted for resuscitation and planned delayed operative intervention.
Discussion:
The patient underwent complete open enucleation secondary to location and in an attempt to limit injuries to or resection of small bowel. Pathological analysis revealed a mesenteric cyst with fluid culture positive for Propionibacterium acnes without true cystic wall consistent with an infected mesenteric pseudocyst. These lesions are difficult to diagnose secondary to varied presentation and lack of pathognomonic clinical, laboratory and imaging findings. Mesenteric pseudocyst have a low rate of recurrence after removal; however, surgical management is mandated due to risks of malignant transformation.
Conclusion:
This is a rare case of a mesenteric pseudocyst of small size presenting with lifelong abdominal pain secondary to its location near the root of the mesentery and inflammatory reaction secondary to infection. It is important to maintain a high index of suspicion for mesenteric cyst as many complications may result if misdiagnosed or without proper surgical management.
Insights
This case highlights a rare infected mesenteric pseudocyst causing lifelong abdominal pain. Surgical removal is crucial due to potential complications and risk of malignant transformation.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Mesenteric pseudocysts are rare gastrointestinal tumors, often asymptomatic and incidentally discovered.
- While typically benign, they can cause symptoms based on size, location, and malignant transformation risk.
Observation:
- A 24-year-old male presented with chronic migratory abdominal pain, nausea, and acute pain.
- CT imaging revealed a mesenteric cyst and pelvic free fluid.
- The cyst measured 4.3 × 4.0 × 4.0 cm.
Findings:
- Surgical enucleation was performed to preserve small bowel integrity.
- Pathology confirmed an infected mesenteric pseudocyst with Propionibacterium acnes, lacking a true cystic wall.
- Diagnosis is challenging due to varied presentations and non-specific findings.
Implications:
- Infected mesenteric pseudocysts require high clinical suspicion for accurate diagnosis and management.
- Surgical intervention is mandated to mitigate risks of complications and potential malignant changes.
- Complete removal offers a low recurrence rate for these rare abdominal masses.
