Radiological Case of the Month | Gastroenterology | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Navigation Landing]
Special Feature
March 2001

Radiological Case of the Month

Arch Pediatr Adolesc Med. 2001;155(3):414. doi:10.1001/archpedi.155.3.413

Denouement and Discussion: Mesenteric Cyst

Figure 1. An abdominal computed tomographic scan revealed a large cystic mass displacing the bowel superiorly.

Figure 2. Surgically resected specimen revealing a thin-walled, bilobed cyst containing clear amber fluid.

Based on the findings of the abdominal computed tomographic scan, surgery was planned. A large, bilobed mesenteric cyst was found, involving the ileum. The cyst was removed, and segmental intestinal resection with primary anastomosis was necessary. The pathologist identified the cyst as a cystic lymphangioma of the mesentery.

Mesenteric cysts are rare, benign, intra-abdominal tumors, and fewer than 1000 cases are reported since Benevieni's original description in 1505.1,2 One third of reported cases involve children younger than age 10 years.3,4 The incidence of mesenteric cysts in children ranges from 1 per 11 250 to 1 per 34 000 hospitalizations.2,5 Most are considered congenital in origin. Proposed mechanisms of development include sequestration or obstruction of lymphatic vessels and ectopic lymphatic tissue.6-8 Mesenteric cysts may arise from trauma, infection, or neoplasm.6 They are grouped with omental and retroperitoneal cysts because of a common origin and histologic features.9

Mesenteric cysts are described in the mesentery from the duodenum to the rectum; however, half are found in the small intestine mesentery, usually near the ileum.2,4,5,9 The patterns of presentation include specific abdominal signs and the incidental finding of an abdominal mass.10 Presentation relates to size, location, and associated complications. Most children with mesenteric cysts are symptomatic; only 20% of mesenteric cysts in children are asymptomatic.2 A palpable mass is found on physical examination in 30% to 50% of affected children.2,3,9,11 Occasionally, these patients are surgical emergencies, particularly when there is intestinal obstruction or appendicitis.9,12 Other presentations include acute abdomen due to hemorrhage, rupture, or torsion of the cyst, which may predispose to volvulus with resultant intestinal infarction.13,14

Diagnosis is not made by history, clinical features, or findings from laboratory examination; radiological evaluation is necessary. Findings from abdominal radiographs are normal or show bowel displacement by the mass. Sometimes calcifications are seen in the cyst wall. The more useful modalities that demonstrate the cystic nature of the mass are abdominal ultrasound or computed tomographic scan.10

The treatment of choice for mesenteric cysts is complete surgical excision. In 33% to 60% of children with mesenteric cysts, segmental bowel resection is required to fully excise the cyst.2,3,5 Although the greatest experience is with open surgery, laparoscopic surgery has been used.15,16 Marsupialization is performed in approximately 10% of the cases.2,5 Neither partial resection nor cyst aspiration is adequate treatment, and both result in a high recurrence rate, while patients with total excision have a negligible risk of recurrence.

Accepted for publication February 24, 1999.

Reprints: Phyllis R. Bishop, MD, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Blair E. Batson Children's Hospital, University of Mississippi Medical Center, Jackson, MS 39216.

Swartley  WR Mesenteric cysts.  Ann Surg. 1997;85886- 896Google ScholarCrossref
Egozi  ElRicketts  RR Mesenteric and omental cysts in children.  Am Surg. 1997;63287- 290Google Scholar
Bliss  DPCoffin  CMBower  R JStockman  PTTernberg  JL Mesenteric cysts in children.  Surgery. 1994;115571- 577Google Scholar
Burnett  WERosemond  GPBucher  RM Mesenteric cysts: report of three cases, in one of which a calcified cyst was present.  Arch Surg. 1950;60699- 706Google ScholarCrossref
Kurtz  R JHeimann  TMBeck  ARHolt  J Mesenteric and retroperitoneal cysts.  Ann Surg. 1986;203109- 112Google ScholarCrossref
Beahrs  OMJudd  ES  JrDockerty  MD Chylous cysts of the abdomen.  Surg Clin North Am. 1950;301081- 1096Google Scholar
Gross  RE The Surgery of Infancy and Childhood: Its Principles and Techniques.  Philadelphia, PA WB Saunders Co1956;377- 383
Hardin  WJHardy  JD Mesenteric cysts.  Am J Surg. 1970;119640- 645Google ScholarCrossref
Okur  HKüçükaydin  MÖzokutan  BHDurak  ACKazez  AKöse  O Mesenteric, omental, and retroperitoneal cysts in children.  Eur J Surg. 1997;163673- 677Google Scholar
Liew  SCCGlenn  DCStorey  DW Mesenteric cyst.  Aust N Z J Surg. 1994;64741- 744Google ScholarCrossref
Chung  MABrandt  MLSt-Vii  DYazbeck  S Mesenteric cysts in children.  J Pediatr Surg. 1991;261306- 1308Google ScholarCrossref
Hadley  MN The origin of retroperitoneal cystic tumors.  Surg Gynecol Obstet. 1916;22174- 176Google Scholar
Namasivayam  JZiervogel  MAHollman  AS Case report: volvulus of a mesenteric cyst: an unusual complication diagnosed by CT.  Clin Radiol. 1992;46211- 212Google ScholarCrossref
Wong  SWGardner  V Sudden death in children due to mesenteric defect and mesenteric cyst.  Am J Forensic Med Pathol. 1992;13214- 216Google ScholarCrossref
Shimura  HUeda  JOgawa  YIchimiya  HTanaka  M Total excision of mesenteric cysts by laproscopic surgery: report of two cases.  Surg Laparosc Endosc. 1997;7173- 176Google ScholarCrossref
Brentano  LFaccini  Pde Castro Oderich  GS Laparoscopic resection of a mesenteric cyst.  Surg Laparosc Endosc. 1998;8402- 403Google ScholarCrossref