General Abdomen: Mesenteric Mass

Mesenteric Cysts

Basics

  • Cause: Ectopic Lymphatic Proliferation that Fails to Communicate with Lymphatic System
    • Can Be Caused by Trauma, Infection or Neoplasia
  • Fluid: Straw-Colored & Proteinaceous with High Triglycerides

Presentation

  • Nonspecific Symptoms, Often Found Incidentally
  • Abdominal Pain
  • Nausea and Vomiting
  • Constipation
  • Diarrhea

Location

  • Small Bowel (60%)
  • Large Bowel (24%)
  • Retroperitoneum (14.5%)

Treatment

  • Tx: Excision (Prevent Recurrence or Malignant Transformation)
    • Vasculature Not Compromised: Enucleation
    • Vasculature Compromised: Resection of Mesentery & Bowel

Mesenteric Cyst at Laparoscopy 1

Mesenteric Cyst (Arrow) on CT 1

Mesentery Tumors

Types

  • Lymphoma – Most Common Mesenteric Malignancy
    • Classic “Sandwich” Appearance on CT (Lymphadenopathy Surrounding Mesenteric Vessels)
  • Cystic Lymphangioma – Most Common Mesenteric Cystic Tumor
  • Liposarcoma – Sarcoma of Adipose Tissue; Rare in Mesentery
  • *More Likely Malignant if at Root

Diagnosis

  • Most Often Initially Found on Imaging
  • Definitive Diagnosis: CT-Guided Core Needle Biopsy

Treatment

  • Tx: Resection; Possibly Chemotherapy for Lymphoma

References

  1. Abdelaal A, Sulieman I, Aftab Z, Ahmed A, Al-Mudares S, Al Tarakji M, Almuzrakchi A, Toro A, Di Carlo I. Laparoscopy as a Diagnostic and Definitive Therapeutic Tool in Cases of Inflamed Simple Lymphatic Cysts of the Mesentery. Case Rep Surg. 2015;2015:325939. (License: CC BY-3.0)