Mesenteric Cysts: An Overview

Abstract

Mesenteric cysts are unusual abdominal tumors. The clinical presentation of patients with mesenteric cysts is variable and often mimics other intra-abdominal disease processes. In an effort to assess our management of these patients, the medical records of all patients with a diagnosis of mesenteric cyst seen at the Pennsylvania State University, Milton S. Hershey Medical Center, from 1973 through 1988 were reviewed. Patients with omental or retroperitoneal cysts were excluded from this study. The diagnosis was established either by laparotomy or autopsy in 9 patients, 6 women and 3 men with a mean age of 49.6 years. The mean duration of symptoms was 2.4 months (range 5 days to 8.4 months). The most common symptoms were abdominal pain, nausea and early satiety; however, 4 patients were completely asymptomatic. Ultrasound and CT scans were the most helpful diagnostic tests. At elective laparotomy, cysts were managed by enucleation or incontinuity bowel resection. Cysts were found most commonly in the small bowel mesentery (44%) and volumes ranged from 1 to 4,890 cm³ (average 890 cm³). Pathologic examination showed the cyst fluid to be serous in 6 patients and chylous in 2 patients without malignant changes. However, in 1 patient whose cyst was filled with hemorrhagic gelatinous material, histology confirmed a low-grade leiomyoblastoma. There were no operative mortalities and no evidence of recurrence during a mean follow-up period of 44 months. We conclude that because of the definite risk of neoplastic disease, all patients diagnosed with mesenteric cysts either preoperatively or incidentally at laparotomy should undergo enucleation or incontinuity resection as the treatment of choice for mesenteric cysts.