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Amylase Levels Are Useful for Diagnosing Omphalomesenteric Cysts: A Case Report
Hiroko Yoshizawa1, Keita Terui1, Mitsuyuki Nakata1
1Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
Abstract:
Omphalomesenteric cysts are an exceedingly rare type of embryologic remnant of the omphalomesenteric duct. Owing to its rarity and unspecific imaging findings, it is occasionally difficult to diagnose preoperatively. Herein, we report the case of a 15-month-old female with an omphalomesenteric cyst that presented as a painful abdominal mass. Imaging showed a 4 cm cystic lesion just beneath the umbilicus, which also contained a 1 cm enhanced lesion. On the immediate right side of this cyst, a 7 cm hematoma was found within the abdominal wall. Aspiration revealed bloody fluid with an amylase level of 38,250 U/L. She was then diagnosed with an omphalomesenteric cyst, with aberrant pancreas and associated hematoma of the abdominal wall. These findings were confirmed with laparotomy and subsequent pathological examinations. The high level of amylase in the cyst led us to speculate the existence of ectopic pancreatic tissue. Thus, amylase measurement may be considered for the diagnosis of an omphalomesenteric cyst.
Insights
Omphalomesenteric cysts are rare embryologic remnants. High cyst amylase levels may indicate ectopic pancreatic tissue, aiding diagnosis.
Area of Science:
- Pediatric Surgery
- Embryology
- Gastroenterology
Background:
- Omphalomesenteric duct remnants are rare embryologic anomalies.
- Preoperative diagnosis of omphalomesenteric cysts can be challenging due to nonspecific imaging.
- This case highlights a rare presentation of an omphalomesenteric cyst.
Observation:
- A 15-month-old female presented with a painful abdominal mass.
- Imaging revealed a cystic lesion with an enhanced nodule, adjacent to an abdominal wall hematoma.
- Aspiration yielded bloody fluid with markedly elevated amylase levels (38,250 U/L).
Findings:
- The patient was diagnosed with an omphalomesenteric cyst with aberrant pancreatic tissue and an associated abdominal wall hematoma.
- Surgical exploration and pathological examination confirmed these findings.
- Elevated amylase levels in the cyst fluid suggested ectopic pancreatic tissue.
Implications:
- Amylase measurement in cyst fluid may be a valuable diagnostic tool for omphalomesenteric cysts.
- This case underscores the importance of considering rare differential diagnoses in pediatric abdominal masses.
- Understanding the association between omphalomesenteric cysts and ectopic pancreatic tissue can improve patient management.
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