Conservative approach to the acute management of a large mesenteric cyst

Abstract

Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large (21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.

Case-report: A rare cause of an intra-abdominal mass

“…They are often asymptomatic and found incidentally when patients are undergoing investigations or treatment of another condition [4]. Clinical presentation includes nonspecific abdominal pain, abdominal distention, change in bowel habit, nausea, vomiting and an abdominal mass [5]. Rarely, they may present as an acute abdomen as a result of a complication such as intestinal obstruction, ischaemic bowel, volvulus and peritonitis or haemorrhagic shock secondary to rupture or bleeding into the cyst.…”

“…Mesenteric cysts are mostly located in the ileum (60 %), ascending colon (24 %), retroperitoneum (14.5 %) and the omentum [4]. Clinical presentation is variable: often they are asymptomatic and found incidentally when patients are receiving work up for other conditions [5]. When patients are symptomatic, the most common presenting complaints are: pain (82 %), nausea and vomiting (45 %), constipation (27 %), and diarrhoea (6 %).…”

Management of a huge symptomatic hemorrhagic mesenteric cyst

“…However, Leung et al have demonstrated that, in acute settings, conservative management followed by elective surgery is also a safe approach. 1 In our case, the patient's main concern of abdominal pain was managed conservatively with analgesics and broad-spectrum antibiotics, and laparotomy was performed 1 week later.…”

“…Mesenteric cysts are uncommon benign intra-abdominal tumors that occur across the life course, with a reported incidence of 1/100 000 in adults and 1/20 000 in children and a female-to-male ratio of 2:1. 1 Lesions are typically located in the small bowel mesentery (66%) or large bowel mesentery (33%), 2 with occasional extension to the retroperitoneum. 3 Depending on their size and location, these cysts are often asymptomatic and are thus discovered incidentally during routine imaging; symptomatic cases may present with acute or chronic vague abdominal pain (55%-81%), a palpable mass (44%-61%), abdominal distension (17%-61%), nausea and vomiting (45%), constipation (27%), or diarrhea (6%).…”

Cystic Lymphangioma of the Greater Omentum: A Case of Partial Spontaneous Regression and Review of the Literature

“…Omental and mesenteric cysts are uncommon benign tumors usually occurring in children with an incidence of 1/20000 at infancy and 1/100000 to 1/250000 of hospital admissions in adults [1]. Sixty-five percent of cases are present at birth, and the female-to-male ratio is 2 : 1 [2]. In adults, they are rare and found in the age group between 40 and 70 years [3].…”