Related Experiment Videos
Mesenteric, omental, and retroperitoneal cysts in children: a clinical study of 22 cases
A Hebra1, M F Brown, K M McGeehin
1Division of Pediatric Surgery, Children's Hospital of Philadelphia, PA 19104.
Insights
Cystic lymphangiomas of the mesentery, omentum, and retroperitoneum are rare pediatric surgical conditions. Complete surgical excision offers a good prognosis, but long-term follow-up is recommended due to potential recurrence.
Area of Science:
- Pediatric Surgery
- Surgical Pathology
- Abdominal Imaging
Background:
- Cystic lesions in the mesentery, omentum, and retroperitoneum are uncommon, particularly in pediatric patients.
- Lymphangiomas represent the most frequent histologic diagnosis for these rare cystic masses.
- Presentation varies from acute abdomen to asymptomatic abdominal masses, often affecting children under five.
Purpose of the Study:
- To review the clinical presentation, diagnosis, surgical management, and outcomes of rare cystic lesions in pediatric patients.
- To evaluate the diagnostic accuracy of imaging modalities, specifically ultrasonography, in identifying these lesions.
- To assess the recurrence rates and long-term prognosis following surgical intervention.
Main Methods:
- Retrospective review of 22 pediatric patients treated surgically for mesenteric, omental, or retroperitoneal cystic lesions between 1956 and 1990.
- Analysis of patient demographics, clinical presentation, diagnostic methods (including abdominal ultrasonography), surgical procedures, and follow-up data.
- Histologic confirmation of lymphangioma in all cases.
Main Results:
- Lymphangioma was the definitive diagnosis in all 22 pediatric patients.
- Abdominal ultrasonography diagnosed a cystic mass in 94% of cases, but pre-operative diagnosis of lymphangioma was only achieved in 24%.
- Complete surgical resection was successful in 82% of patients, with a mean follow-up of 23 months revealing three recurrences without reoperation.
Conclusions:
- Surgical excision is the primary treatment for pediatric cystic lymphangiomas, yielding a favorable prognosis.
- Despite successful resection, long-term surveillance is crucial due to the possibility of recurrence, even in adulthood.
- Early and accurate diagnosis remains challenging, highlighting the need for improved pre-operative identification strategies.
Abstract:
Cystic lesions of the mesentery, omentum, and retroperitoneum are rare; from 1956 to 1990, 22 patients had operative treatment for such lesions at our institution. They ranged in age from 1 month to 14 years; 75% were younger than 5 years. All had either an acute abdomen or, more commonly, a silent abdominal mass. In all cases, the histologic diagnosis was lymphangioma. Abdominal ultrasonography was done in all cases after 1977 except for two patients who had an acute abdomen requiring emergency exploration. A cystic abdominal mass was diagnosed in 94% of these cases, but the correct diagnosis of lymphangioma was made prior to surgery in only 24%. Mesenteric cysts are most common in the small bowel mesentery. Omental cysts usually occur singly and are easily resected, but multiple cysts predominate in the mesentery and retroperitoneum. Complete resection was accomplished in 82% of our cases. Two patients required partial bowel resection, and four had partial excision with marsupialization of the cysts. With a mean follow-up of 23 months, we have had three recurrences, but none necessitated reexploration. Extra-abdominal lesions, mainly cutaneous lymphangiomas, developed in two cases. Prognosis is good after surgical excision, but long-term follow-up is advisable because of the possibility of recurrence, even during adulthood.