Diagnostic Approach of Mesenteric Cyst in Children: A Case Report

Authors

  • Asep Aziz Purnama Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Hanifah Oswari Gastroenterology Division, Department of Child Health, Universitas Indonesia , Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.58427/apghn.3.3.2024.32-7

Keywords:

abdominal distension, bowel obstruction, diagnostic approach, mesenteric cysts, ultrasound

Abstract

Background: Mesenteric cysts are intra-abdominal masses that arise from obstructed lymphatic drainage within the mesentery. Early diagnosis can be challenging, as it is often difficult to recognize based solely on clinical findings. The diagnosis is frequently made following imaging studies or during surgery. Despite their generally benign nature, delayed diagnosis can lead to serious complications. This case report aims to share our experience on the diagnostic approach for mesenteric cysts in children.

Case: A 2-year-old boy presented with a 14-month history of slowly progressive abdominal distension and signs of bowel obstruction, including weight loss. Abdominal ultrasound revealed thin-walled, well-demarcated, septated fluid sacs consistent with a cyst. Abdominal CT-Scan showed massive ascites filling the intraperitoneal cavity and pushing the intestine upward along the thickened mesentery, causing bowel obstruction. Histopathological examination confirmed the diagnosis of cyst lymphangioma derived from mesentery. The cyst was successfully excised via laparotomy, and histological examination confirmed it as a cystic lymphangioma.

Discussion: Our diagnostic approach focused on exclusion of differential diagnosis for abdominal distention in children, including ascites, abdominal tuberculosis, mesenteric cysts, and intra-abdominal masses. The absence of constitutional symptoms and lack of response to anti-tuberculosis therapy made it an unlikely diagnosis. While the CT-scan suggested ascites, the ultrasound results suggested a mesenteric cyst. Despite its large size, a complete excision of the cyst was successfully performed via laparotomy.

Conclusion: The nonspecific nature of mesenteric cysts often delays diagnosis, making abdominal ultrasound an essential initial imaging modality for patients suspected of having this condition.

References

Yoon JW, Choi DY, Oh YK, Lee SH, Gang DB, Yu ST. A Case of Mesenteric Cyst in a 4-Year-Old Child with Acute Abdominal Pain. Pediatr Gastroenterol Hepatol Nutr. 2017;20(4):268-72. https://doi.org/10.5223/pghn.2017.20.4.268 DOI: https://doi.org/10.5223/pghn.2017.20.4.268

Pithawa AK, Bansal AS, Kochar SP. Mesenteric cyst: A rare intra-abdominal tumour. Med J Armed Forces India. 2014;70(1):79-82. https://doi.org/10.1016/j.mjafi.2012.06.010 DOI: https://doi.org/10.1016/j.mjafi.2012.06.010

Kusuma P, Putra MDP, Suwardi S. Mesenteric Cystic Lymphangioma in Pediatric Patient: A Rare Intra-Abdominal Tumor Management in Rural Country Case Report. Open Access Macedonian Journal of Medical Sciences. 2021;9(C):84-8. https://doi.org/10.3889/oamjms.2021.6134 DOI: https://doi.org/10.3889/oamjms.2021.6134

Robbins KJ, Antiel RM, Shakhsheer BA. Omental cyst: a case report and review of the literature. Ann Pediatr Surg. 2021;17(1):62. https://doi.org/10.1186/s43159-021-00129-0 DOI: https://doi.org/10.1186/s43159-021-00129-0

Gunadi, Kashogi G, Prasetya D, Fauzi AR, Daryanto E, Dwihantoro A. Pediatric patients with mesenteric cystic lymphangioma: A case series. Int J Surg Case Rep. 2019;64:89-93. https://doi.org/10.1016/j.ijscr.2019.09.034 DOI: https://doi.org/10.1016/j.ijscr.2019.09.034

Tripathy PK, Jena PK, Pattnaik K. Management outcomes of mesenteric cysts in paediatric age group. Afr J Paediatr Surg. 2022;19(1):32-5. https://doi.org/10.4103/ajps.AJPS_158_20 DOI: https://doi.org/10.4103/ajps.AJPS_158_20

Wyers S G, Matthews JB. Sleisenger and fordtran’s gastrointestinal and liver disease. 11 ed: Elsevier; 2022.

Malikowski T, Mahmood M, Smyrk T, Raffals L, Nehra V. Tuberculosis of the gastrointestinal tract and associated viscera. J Clin Tuberc Other Mycobact Dis. 2018;12:1-8. https://doi.org/10.1016/j.jctube.2018.04.003 DOI: https://doi.org/10.1016/j.jctube.2018.04.003

Chen J, Du L, Wang DR. Experience in the diagnosis and treatment of mesenteric lymphangioma in adults: A case report and review of literature. World J Gastrointest Oncol. 2018;10(12):522-7. https://doi.org/10.4251/wjgo.v10.i12.522 DOI: https://doi.org/10.4251/wjgo.v10.i12.522

Mullaney TG, D'Souza B. Mesenteric cyst: an uncommon cause of acute abdomen. ANZ J Surg. 2019;89(3):E98-e9. https://doi.org/10.1111/ans.14067 DOI: https://doi.org/10.1111/ans.14067

Rudralingam V, Footitt C, Layton B. Ascites matters. Ultrasound. 2017;25(2):69-79. https://doi.org/10.1177/1742271x16680653 DOI: https://doi.org/10.1177/1742271X16680653

Lal SB, Bolia R, Menon JV, Venkatesh V, Bhatia A, Vaiphei K, et al. Abdominal tuberculosis in children: A real-world experience of 218 cases from an endemic region. JGH Open. 2020;4(2):215-20. https://doi.org/10.1002/jgh3.12245 DOI: https://doi.org/10.1002/jgh3.12245

Chou YH, Tiu CM, Lui WY, Chang T. Mesenteric and omental cysts: an ultrasonographic and clinical study of 15 patients. Gastrointest Radiol. 1991;16(4):311-4. https://doi.org/10.1007/bf01887376 DOI: https://doi.org/10.1007/BF01887376

Junichiro Kawamura, Hokuto Ushijima, Yasumasa Yoshioka, Koji Daito, Kazuki Ueda, Tadao Tokoro, et al. Laparoscopic Treatment of Mesenteric Cysts: Report of Two Cases With a Literature Review. Int Surg. 2019;104(1):348–51. https://doi.org/10.9738/INTSURG-D-17-00059.1 DOI: https://doi.org/10.9738/INTSURG-D-17-00059.1

Guraya SY, Salman S, Almaramhy HH. Giant mesenteric cyst. Clin Pract. 2011;1(4):e108. https://doi.org/10.4081/cp.2011.e108 DOI: https://doi.org/10.4081/cp.2011.e108

Aliukonis V, Lasinskas M, Pilvelis A, Gradauskas A. Pathological Discrepancy: Simple Mesenteric Cyst vs. Mesenteric Lymphangioma. Case Rep Surg. 2021;2021:8848462. https://doi.org/10.1155/2021/8848462 DOI: https://doi.org/10.1155/2021/8848462

Published

2024-08-31

How to Cite

1.
Diagnostic Approach of Mesenteric Cyst in Children: A Case Report. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2024 Aug. 31 [cited 2024 Nov. 21];3(3):32-7. Available from: https://apghn.com/index.php/journal/article/view/71