Novel diagnosis of mesenteric endometrioma

Abstract

Rationale: Mesenteric cysts are benign gastrointestinal cystic lesions, with an incidence of <1/100 000. They usually develop in the small bowel mesentery, mesocolon (24%), retroperitoneum (14.5%), and very rarely originate from the sigmoid mesentery. Endometriomas represent a localized type of endometriosis and are usually within the ovary. Our case is unique because there are no reports in the literature of endometrial mesenteric cysts. Patient concerns: We present a case of a 29-year-old woman who underwent a routine gynecologic control. Diagnosis: Clinical examination and imaging identified 2 endometriomas on the left and posterior to the uterus. Interventions: The patient underwent exploratory laparoscopy. Unexpectedly, a 10 cm mesenteric cyst was identified; this was associated with adhesions in the left adnexal area and a left ovarian endometrioma. The classic surgical approach which was necessary identified the mesenteric cyst with cranial mesosigmoid and ileal adhesions, as well as distal adhesions which included the uterus, ileum, left ovarian endometrioma, left hydrosalpinx, left ureter, and rectum. The cyst was removed completely and a left adnexectomy was performed because of the presence of the endometrioma and adhesions. Outcomes: The patient's outcome was favorable, with discharge at 72 hours after surgery. The histopathological report revealed that both the mesenteric and ovarian cysts were endometriomas. Lessons: Our case is unusual in that a mesenteric cyst was identified in a patient with no clinical symptoms. Furthermore, the histopathological examination revealed the endometriotic origin of the mesenteric cyst which has not previously been reported in the literature.

Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge

“…A misplaced appendix may be easily confused with endometriosis of the mesorectum, which is usually superficial and presents as a peritoneal implant of endometriosis ( Figure 4 ) [ 48 ]. Cystic endometriosis beneath the rectum is very rare [ 49 ] compared with benign cysts of sacral nerve roots.…”