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Mesenteric cysts in children
D P Bliss1, C M Coffin, R J Bower
1Department of Surgery, St. Louis Children's Hospital, St. Louis, Mo.
Insights
Mesenteric cysts are rare abdominal masses in children, often presenting as abdominal pain. Ultrasonography can help diagnose these cysts, especially when appendicitis is ruled out.
Area of Science:
- Pediatric Surgery
- Abdominal Imaging
- Gastroenterology
Background:
- Mesenteric cysts are uncommon benign abdominal masses.
- Children constitute approximately one-third of patients with these lesions.
Purpose of the Study:
- To investigate the clinical presentation and diagnostic methods for mesenteric cysts in pediatric patients.
- To evaluate the role of ultrasonography in diagnosing abdominal pathologies in children.
Main Methods:
- Retrospective review of clinical records over 14 years.
- Inclusion of 10 pediatric patients diagnosed with mesenteric cysts.
- Analysis of imaging findings, clinical presentation, and surgical outcomes.
Main Results:
- Abdominal pain was the primary complaint in 9 out of 10 patients.
- Five patients presented with symptoms mimicking acute surgical abdomen, including appendicitis.
- Cystic lymphangiomas were the most common type, found in 8 out of 10 cases.
Conclusions:
- Mesenteric cysts should be considered in the differential diagnosis of pediatric abdominal pain.
- Ultrasonography is a reliable initial imaging study for acute surgical abdomen in children.
- Extended abdominal ultrasonography can identify mesenteric cysts when appendicitis is unlikely.
Background:
Mesenteric cysts are uncommon benign abdominal masses. Approximately one third of patients with these lesions are children.
Methods:
We reviewed our clinical records for the past 14 years (corresponding to the period of time in which ultrasonography and computed tomography became reliable methods for imaging pediatric patients) and found 10 patients with mesenteric cysts.
Results:
We were surprised to discover that abdominal pain was a presenting complaint in all but one patient. Five of the patients had the findings of an acute surgical abdomen and were thought to have appendicitis. Two patients operated on for appendicitis were transferred to our hospital with the diagnosis of an abdominal mass. In each case the mass was a mesenteric cyst. Cyst distribution included the small-bowel mesentery in seven patients, the transverse mesocolon in two patients, and the right mesocolon in one patient. Six cases required concomitant bowel resection for the cyst removal, and all were cystic lymphangiomas. The resected specimens were described as cystic lymphangiomas in eight of the 10 cases.
Conclusions:
Mesenteric cysts should be considered as an origin for abdominal pain in children, particularly after exclusion of more common diagnoses. We have found ultrasonographic imaging to be a reliable method for the diagnosis of appendicitis in children and advocate its use as an initial imaging study in patients with an acute surgical abdomen and presumed appendicitis. If appendicitis is indicated unlikely by ultrasonogram, the examination can be extended to the remainder of the abdomen, which can reveal mesenteric cysts or other pathologic conditions.