Mesenteric pseudocyst of the sigmoid colon

Abstract

A 31-year-old woman with right lower abdominal pain was hospitalized. Palpation revealed both tenderness and rebound tenderness in the right lower quadrant of her abdomen. Abdominal ultrasonography (US) indicated a multilocular cystic mass on the right side of the pelvic area, and a computed tomography (CT) scan showed a low-density mass measuring 7 cm in diameter. Torsion of the pedicle of a right ovarian cyst was suspected, and emergency laparotomy was performed. At operation, however, the uterus and both ovaries appeared normal, and exploration revealed a yellow-reddish cystic mass, approximately 10 cm in size, in the subserosa of the sigmoid colon. The mass was excised together with a 10-cm segment of the sigmoid colon. Macroscopically, it was a multilocular cyst, measuring 10 x 10 cm in size, and it contained white gelatinous fluid. Histological examination showed the cyst wall to be composed of neutrophils, lymphocytes, fibrin, and fibroblasts, but neither a specific endothelial lining nor proliferating lining was detected. The final pathological diagnosis was a mesenteric pseudocyst. Mesenteric pseudocysts are rare, and only 14 cases have been reported previously in the Japanese literature. Emergency operation was performed in 3 patients, including our own. The etiology of these three pseudocysts (manifested by acute abdomen) was unknown. We suspect that inflammation spread and injured lymph vessels, causing lymph to leak out and pool under the subserosal layer.

Mesenteric Cyst of the Descending Colon: Report of a Case

“…They are usually found in the small intestine mesentery (66%) but also in the mesentery of the large intestine (33%), usually in the right colon (2, 5-9). Very few have been reported in the mesentery of the descending colon or sigmoid, including our case (5). Since the first reported case in 1507 and the first successful surgical excision by TILLAUX in 1880, approximately 820 cases, including our own, have been reported (1,10,11).…”

“…Sometimes, their first manifestation is one of their complications such as torsion, rupture or haemorrhage of the cyst and adjacent organ obstruction (intestine, ureters). In these cases the cysts are discovered during emergency laparotomy (1,5,9,15). In our case, a four month history of diffuse pain and fullness is mentioned and the first suspicion, which led to the diagnosis was during a routine gynaecological examination.…”

“…In fact the CT did not clearly define the origin or the relation of the cyst with the kidneys contrarily to the MRI scan which provided a definite diagnosis. Symptoms of diffuse abdominal pain, sensation of fullness or pressure in the abdomen, particularly after meals maybe present in some cases (1,5,16). Sometimes, their first manifestation is one of their complications such as torsion, rupture or haemorrhage of the cyst and adjacent organ obstruction (intestine, ureters).…”

Mesenteric pseudocyst of the transverse colon: unusual presentation of more common pathology

“…2 3 Among these, (non-pancreatic) pseudocysts, though not related to pancreatitis, are histologically similar to pancreatic pseudocysts, and the wall of the cyst is composed of fibrous tissue and characterised by the absence of epithelial lining cells. Mesenteric pseudocysts are rare and only few case reports have been noted until now 1 6 7. They generally occur secondary to trauma or infection, and are thought to be a haematoma that manifests itself in the mesentery or omentum, or a trace of an abscess that was not completely absorbed 7 8.…”

Pseudomesenteric cyst

“…Emergency operation was performed in only 3 patients. The etiology of the pseudocyst manifested by acute abdomen was unknown [1]. A case of pseudomesenteric cyst presented in the emergency with acute abdomen is reported here.…”