Excéresis de quiste mesentérico gigante en paciente femenina de 36 años / Excision of a giant mesenteric cyst in a 36-year-old female patient

INTRODUCCIÓN: Los quistes mesentéricos son tumores intra-abdominales definidos como cualquier quiste en el mesenterio del tracto gastrointestinal, ubicándose más frecuentemente en intestino delgado (íleon 60%) cuya incidencia es de tan solo 1 en 350.000 casos, haciendo relevante la publicación de los casos identificados para ampliar el conocimiento y conducta que se debe tener frente a los mismos. CASO CLÍNICO: Se trata de una paciente femenina de 36 años de edad, que acudió con cuadro de dolor abdominal acompañado de importante aumento del diámetro abdominal de un año de evolución, agudizado hace 4 días, por lo que se realizó ecografía abdominal donde se observó una masa quística de aproximadamente 7554ml, completando con estudio tomográfico donde no se observó aparente compromiso de grandes vasos, identificándose quirúrgicamente masa quística dependiente de mesenterio que comprometía la tercera y cuarta porción del duodeno, por lo que requirió resección de las mismas con anastomosis primaria, tras lo cual paciente mostró adecuada respuesta tras el procedimiento. DISCUSIÓN: El tratamiento de elección frente a un quiste mesentérico es la resección del mismo, debido a que otros métodos han mostrado altas tazas de recurrencia, sin embargo, el abordaje quirúrgico varía de acuerdo al cuadro clínico, teniendo como primera opción la resolución laparoscópica, no obstante, se optó por la realizar una laparotomía dado el gran volumen del quiste evidenciado en estudios de imagen. CONCLUSIONES: Los quistes mesentéricos tienen buen pronóstico una vez que son resecados completamente, sin embargo, es importante tomar en cuenta que el riesgo de compromiso vascular se vincula con el tamaño del mismo, algo que se puede confirmar solo durante el procedimiento quirúrgico, es por ello que se debe anticipar estas situaciones y tomar las medidas para reducir las consecuencias del mismo.

INTRODUCTION: Mesenteric cysts are intra-abdominal tumors defined as any cyst in the me-sentery of the gastrointestinal tract, most frequently located in the small intestine (ileum 60%) whose incidence is only 1 in 350,000 cases, making the publication of the cases relevant. iden-tified to expand the knowledge and behavior that must be followed regarding them. CLINICAL CASE: This is a 36-year-old female patient who presented with abdominal pain accompanied by a significant increase in abdominal diameter for one year, exacerbated 4 days ago, so an abdominal ultrasound was performed where a cystic mass of approximately 7554 ml, completed with a tomographic study where no apparent involvement of the great vessels was observed, surgically identifying a cystic mass dependent on the mesentery that compromised the third and fourth portions of the duodenum, which required resection of the same with primary anastomosis, after which the patient showed an adequate response after the procedure. DISCUSSION: The treatment of choice for a mesenteric cyst is its resection, because other methods have shown high rates of recurrence; however, the surgical approach varies according to the clinical picture, with laparoscopic resolution being the first option; however, it was decided to perform a laparo-tomy given the large volume of the cyst evident in imaging studies. CONCLUSION: Mesenteric cysts have a good prognosis once they are completely resected, however, it is important to take into account that the risk of vascular compromise is linked to its size, something that can be confirmed only during the surgical procedure, which is why These situations must be anticipated and measures taken to reduce their consequences

Quiste mesentérico gigante, un hallazgo incidental: reporte de caso / Giant mesenteric cyst, an incidental finding: case report / Cisto mesentérico gigante, um achado incidental: relatório de caso

Se presenta el caso de un hombre de 58 años de edad, sin antecedentes de importancia para la presencia de hepatopatía, quien presentó distensión abdominal progresiva que no respondió al manejo a base de diuréticos, diagnosticado incidentalmente a través de estudios de imagen con un quiste mesentérico gigante, el cual constituye un tumor raro, con pocos reportes de caso en la literatura, según lo referido es más frecuente en el sexo femenino, su etiología aun es desconocida, su diagnóstico generalmente se realiza a través de estudios de imagen y el tratamiento consiste en la escisión quirúrgica completa ya que su drenaje constituye un medio ineficaz por el alto riesgo de recurrencia.

We present the case of a 58-year-old man, with no history of significant hepatopathy, who presented progressive abdominal distension that did not respond to diuretics, diagnosed incidentally through imaging studies with a giant mesenteric cyst, which is a rare tumor, Its etiology is still unknown, its diagnosis is generally made through imaging studies and the treatment consists of complete surgical excision since its drainage is an ineffective means due to the high risk of recurrence.

Apresentamos o caso de um homem de 58 anos, sem historial de hepatopatia significativa, que apresentava uma distensão abdominal progressiva que não respondia a uma gestão baseada em diuréticos, diagnosticada incidentalmente através de estudos de imagem com um cisto mesentérico gigante, que é um tumor raro, A sua etiologia é ainda desconhecida, o seu diagnóstico é geralmente feito através de estudos de imagem e o tratamento consiste na excisão cirúrgica completa, uma vez que a drenagem é um meio ineficaz devido ao elevado risco de recidiva.

Quiste mesentérico gigante como simulador de ascitis: reporte de un caso y revisión de la literatura / Giant mesenteric cyst mimicking ascites: a case report and review of the literature

Introducción. Los quistes mesentéricos son tumores poco frecuentes y usualmente benignos, que se diagnostican principalmente en la edad pediátrica, de manera incidental.Caso clínico. Se presenta el caso de una paciente de cuatro años de edad, con dificultad para acceso a servicio de salud por localización de su vivienda, quien cursa con un cuadro clínico de dos años de evolución de distensión abdominal progresiva, interpretada y manejada como ascitis. Se realizó una tomografía de abdomen en la que se documentó una lesión quística gigante, por lo que fue llevada a resección por laparotomía, con confirmación histopatológica de un quiste mesentérico. Discusión. Los quistes mesentéricos pueden tener cualquier localización en el mesenterio del tracto gastrointestinal. Su principal etiología es la proliferación anormal y benigna de tejido linfático mesentérico. Las manifestaciones clínicas van desde la ausencia de síntomas hasta el abdomen agudo. Dentro de los síntomas abdominales no agudos se encuentran masa abdominal indolora, dolor abdominal, distensión abdominal y signos clínicos que simulan ascitis. La resección completa del quiste mesentérico es considerada el tratamiento de elección; el abordaje laparoscópico o abierto dependerá de las características clínicas de cada paciente y la experiencia del cirujano tratante. Conclusión. Es importante que los cirujanos conozcan las principales características y el manejo de esta entidad, que una vez presente, puede simular un síndrome ascítico.

Introduction. Mesenteric cysts are rare and usually benign tumors, which are diagnosed incidentally, mainly in children.Clinical case. We present the case of a 4-year-old patient, with difficulty accessing health services due to the location of her home, who has a 2-year history of progressive abdominal distension, interpreted and managed as ascites. An abdominal tomography was performed in which a giant cystic lesion was documented. She underwent resection by laparotomy, with histopathological confirmation of a mesenteric cyst. Discussion. Mesenteric cysts can have any location in the mesentery of the gastrointestinal tract. Its main etiology is the abnormal and benign proliferation of mesenteric lymphatic tissue. Clinical manifestations range from the absence of symptoms to an acute abdomen. Non-acute abdominal symptoms include a painless abdominal mass, abdominal pain, abdominal distension, and clinical signs that mimic ascites. Complete resection of the mesenteric cyst is considered the treatment of choice; laparoscopic or open approach will depend on the clinical characteristics of each patient and the experience of the treating surgeon. Conclusion. It is important for surgeons to know the main characteristics and management of this entity, which once present, can mimic an ascites syndrome

Quiste mesentérico gigante: reporte de caso / Giant mesenteric cyst. Case report

Resumen El quiste mesentérico es una patología intraabdominal poco frecuente, en su mayoría benigna. El tratamiento casi siempre es quirúrgico y consiste en la resección del quiste y de los órganos involucrados siempre que sea posible con el fin de reducir la tasa de recurrencia. Se presenta el caso de un paciente de 38 años con dolor abdominal inespecífico y diagnóstico ecográfico de masa retroperitoneal zona II izquierda gigante. Los estudios de extensión incluyeron tomografía axial computarizada, resonancia magnética y endoscopia de vías digestivas altas, cuyos hallazgos informaron una lesión quística gigante. Se realizó resección quirúrgica de la lesión por vía abierta, con diagnóstico histopatológico de quiste mesentérico.

Abstract A mesenteric cyst is a rare, mostly benign, intra-abdominal tumor. Treatment is almost always surgical and consists of removing the cyst and involved organs whenever possible to prevent recurrence. The following is the case of a 38-year-old patient with nonspecific abdominal pain and an ultrasound diagnosis of a giant retroperitoneal mass in the left medial paracolic gutter. The following imaging studies were performed: computed tomography, magnetic resonance, and endoscopy, finding a giant cystic lesion. An exploratory laparotomy was performed to remove the mass, and a histopathology report confirmed the diagnosis of mesenteric cyst.

El paraganglioma como tumor mesentérico infrecuente / Mesenteric paraganglioma: a rare tumor

RESUMEN Los paragangliomas son tumores originados en las células neuroendocrinas que forman el sistema nervioso autónomo. Se consideran benignos aunque pueden desarrollar malignidad, por lo que su tra tamiento es quirúrgico. La presentación de paraganglioma de ubicación mesentérica es muy inusual.

ABSTRACT Paragangliomas are rare neuroendocrine tumors that arise in the autonomic nervous system. Although these tumors are considered benign, they must be removed by surgery due to their potential malig nant transformation. Mesenteric paragangliomas are extremely rare.

Linfagioma quístico mesentérico en el diagnóstico diferencial de la enfermedad in-flamatoria pélvica / Mesenteric cystic lymphangioma in the differential diagnosis of pelvic inflammatory disease

RESUMEN La enfermedad inflamatoria pélvica (EIP) es un síndrome clínico que incluye todas aquellas alteraciones inflamatorias e infecciosas que comprenden los órganos de la pelvis menor. La infección es habitualmente polimicrobiana y está asociada a mujeres jóvenes con vida sexual activa, nulíparas y usuarias de dispositivo intrauterino (DIU Los abscesos tubo-ováricos son una complicación aguda o crónica, asociada a dicho proceso.). CASO CLÍNICO Presentamos el caso de una mujer de 47 años con dolor abdominal intenso, usuaria de DIU. La primera sospecha diagnóstica fue de EIP con presencia de absceso tuboovárico anexial. Sin embargo la exploración física no orientó en este sentido, por lo que se solicitó TAC abdominopélvico, en el que se informó de la posibilidad de linfangioma quístico mesentérico. Por ello, se contactó con el servicio de Cirugía General que procedió a su resección satisfactoria y sin incidencias. El estudio anatomopatológico confirmo la sospecha radiológica. CONCLUSIÓN Una adecuada exploración física es fundamental en el diagnóstico de la EIP y el absceso tuboovárico. El linfangioma quístico mesentérico puede formar parte del diagnóstico diferencial de las masas anexiales en este contexto.

ABSTRACT Pelvic inflammatory disease (PID) is a clinical syndrome involving all those inflammatory and infectious alterations affecting the minor pelvis organs. Any infection is often multibacterial and more frequent in sexually active nulliparous young women and intrauterine device (IUD) users. Tuboovarian abscesses can be an acute or chronic complication associated to that process. Our patient was a 47 year old IUD user consulting about intense abdominal pain. The initial clinical suspicion pointed at a case of PID associated to a tubo-ovarian anexial abscess. However, a physical examination did not support this suspicion and an abdominopelvian CAT scan was therefore requested, reporting a possible mesenteric cystic lymphangioma. The General Surgery service was reached for treatment, successfully excising the growth without further incident. Histological analysis confirmed the radiological diagnosis. An adequate physical examination is instrumental while diagnosing PID and tuboovarian abscesses. A mesenteric cystic lymphangioma should be included in a differential diagnosis of anexial growths in such a context

Abdomen agudo quirúrgico secundario a Linfangioma quístico abdominal / Acute abdomen due to abdominal cystic lymphangioma

Los linfangiomas quísticos abdominales son benignos y poco frecuentes, que se presentan mayormente en niños. Puede presentarse como molestias inespecíficas abdominales, hallazgo incidental o abdomen agudo. Por lo que se presenta el caso de una niña de 3 años que debutó con un cuadro de abdomen agudo. (AU)

Abdominal cystic lymphangiomas are benign and infrequent conditions mostly seen in children. Clinical presentation is with non-specific manifestations or with an acute abdomen. We report here the case of a 3-year old girl presenting with an acute abdomen. (AU)

A Case of Mesenteric Cyst in a 4-Year-Old Child with Acute Abdominal Pain / 대한소아소화기영양학회지

Mesenteric cysts are rare intra-abdominal lesions occurring during childhood, which were first described in 1507. Cases of mesenteric cysts have been continuously reported, but these cases were very small in number. They are often asymptomatic and incidentally found while patients are undergoing work-up or receiving treatment for other conditions such as appendicitis, small-bowel obstruction, or diverticulitis; however, patients may still have lower abdominal pain and symptoms that are frequently associated with other abdominal conditions. The symptoms are variable and non-specific, including pain (82%), nausea and vomiting (45%), constipation (27%), and diarrhea (6%). An abdominal mass may be palpable in up to 61% of patients. We are to report the clinical course and literature of a child with mesenteric cysts who complained of acute abdominal pain, distension, and vomiting and were surgically treated after being diagnosed with mesenteric cysts based on radiological examination.

A Case of Mesenteric Cyst in a 4-Year-Old Child with Acute Abdominal Pain / 대한소아소화기영양학회지

Mesenteric cysts are rare intra-abdominal lesions occurring during childhood, which were first described in 1507. Cases of mesenteric cysts have been continuously reported, but these cases were very small in number. They are often asymptomatic and incidentally found while patients are undergoing work-up or receiving treatment for other conditions such as appendicitis, small-bowel obstruction, or diverticulitis; however, patients may still have lower abdominal pain and symptoms that are frequently associated with other abdominal conditions. The symptoms are variable and non-specific, including pain (82%), nausea and vomiting (45%), constipation (27%), and diarrhea (6%). An abdominal mass may be palpable in up to 61% of patients. We are to report the clinical course and literature of a child with mesenteric cysts who complained of acute abdominal pain, distension, and vomiting and were surgically treated after being diagnosed with mesenteric cysts based on radiological examination.

Cysts of Gastrointestinal Origin in Children: Varied Presentation / 대한소아소화기영양학회지

PURPOSE: Abdominal cysts of gastrointestinal origin are rare. Their rarity and varied clinical presentations make their pre-operative diagnosis difficult. METHODS: Fourteen patients with histological diagnosis of cysts of gastrointestinal origin admitted between 2009 and 2015 were retrospectively analyzed with respect to age, sex, clinical presentation, diagnostic modality, site and type of cyst, management, outcome and follow-up. RESULTS: The mean age at presentation was 4 years and there were six males and eight females. Abdominal pain was the most common presenting symptom. Five patients had an acute presentation-three had distal ileal mesenteric cysts and two had ileal duplication cyst sharing a common wall with ileum. Six patients presented with chronic abdominal pain and lump—three patients had omental cysts and three had mesenteric cysts—two of these in distal ileum and one in sigmoid colon. Two patients presented with antenatally diagnosed palpable abdominal lump. One had a mesenteric cyst of the ileum and the other had a distal ileal duplication cyst which required excision with resection and anastomosis. One patient had an atypical presentation. He was a known case of sickle cell trait and had presented with vague abdominal pain, recurrent cough and multiple episodes of haemoptysis over a period of one year. At laparotomy, gastric duplication cyst was found which was excised completely. Histopathology confirmed the diagnosis. CONCLUSION: Cysts of gastrointestinal origin are rare and have varied presentation. Surgical excision is the mainstay of treatment. The results and prognosis are good.

Neoplasia mucinosa quística del mesenterio: presentación de caso y revisión de la literatura / Mucinous cystic neoplasms of the mesentery: Case presentation and literature review

Las neoplasias quísticas mucinosas del mesenterio son infrecuentes, carecen de hallazgos clínicos específicos y usualmente se diagnostican incidentalmente como otros quistes mesentéricos. Presentamos el caso de una mujer de 67 años con un quiste mesentérico erroneamente clasificado en el preoperatorio como un tumor ovárico. Fue extraído completamente y la revisión histológica mostró un cistadenoma mucinoso. Revisamos la literatura y los casos reportados hasta la fecha.

Mucinous cystic neoplasms of the mesentery are rare, have a lack of specific clinical findings, and are usually diagnosed incidentally as other mesenteric cysts. The case is reported on a 67 year-old woman with a mesenteric cyst erroneously classified preoperatively as an ovarian tumor. It was completely resected and histological review showed a mucinous cystadenoma. A review is performed on the literature and cases reported to date.

Quistes de epiplón y mesenterio en niños; revisión de 10 años / Omentum cysts and mesentery cysts in children. A 10 years review

Se revisan los casos de niños operados con diagnóstico de quiste de epiplón (QE) y mesenterio (QM) en el período de Agosto 2003 a Agosto 2013, en el Hospital Dr. Gustavo Fricke de Viña del Mar. Estos son quistes intraabdominales de escasa frecuencia, que evolucionan como tumoración asintomática, pudiendo presentar diversas manifestaciones clínicas desde constipación, vómitos y dolor hasta ser causa de abdomen agudo en el niño. La radiografía de abdomen simple y el ultrasonido pueden ser de utilidad para plantear la sospecha diagnostica, siendo la tomografía computada el estudio de excelencia en estos casos. Se encontró tres pacientes, dos QE y un QM. Los motivos de consulta fueron: masas abdominal (QE), dolor abdominal recurrente (QM) y abdomen agudo (QM). El diagnóstico se confirmó con TAC y se realizo exéresis total de la lesión en todos los casos. En un paciente fue necesaria la resección intestinal complementaria (QM). No hubo complicaciones en nuestros casos.

This is a case review of operated children with diagnosis of omentum cysts (OC) or mesentery cysts (MC), since August 2003 to August 2013 at Dr. Gustavo Fricke Hospital, Viña del Mar, Chile. These are rare intraabdominal lesions that frequently evolve as an asymptomatic tumor; clinical manifestations are constipation, vomits, abdominal pain and occasionally may be cause of acute abdomen in the child. The abdominal radiography and ultrasound may be useful, but the abdominal pelvic CT scan is the gold standard in these affections. Three cases were found, two OC and one MC. Symptoms were: abdominal tumor (OC), recurrent abdominal pain (OC) and acute abdomen (MC). Diagnosis confirmation was made with TC scan in all cases. Total exeresis of the benign tumor lesion was performed in all cases. In one patient it was necessary to perform intestinal resection for the tumor exeresis (MC). There were no complications.

Idiopathic benign retroperitoneal cyst: uncommon retroperitoneal mass

Retroperitoneal cysts are uncommon, with an estimated incidence of 1/5750 to 1/250.000. We found a case of a 54th years old female in Al-Karama Teaching Hospital with sensation of mild left lower abdominal pain colicky in nature with mild backache, ten days duration. No dysuria, normal bowel motion. On physical examination we palpated a fixed mass in the left lateral side of abdomen, ultrasound, and CT-scan were done, first we thought it is probably a mesenteric cyst but this cyst was fixed not mobile in nature. During the operation we found a retroperitoneal cyst at the lateral side of sigmoid colon and extend posterior to the descending colon. The cyst arising within the retroperitoneum outside the major organs. CT scan, and MRI might help in investigation of a retroperitoneal cyst, but surgery is the keystone in confirming the diagnosis, and surgery remains the best treatment option

Quiste mesotelial simple gigante / Giant simple mesothelial CYST

El quiste mesotelial simple es una rara causa de quistes mesentéricos. El tamaño de estas lesiones suele ser de pocos centímetros y por tanto suele ser asintomático siendo su diagnóstico un hallazgo imagenológico o intraoperatorio. Caso clínico: Se documenta el caso de una mujer de 40 años de edad quien presenta un quiste mesotelial simple de gran tamaño y sintomático el cual fue manejado mediante resección quirúrgica completa sien-do este el tratamiento de elección. El comportamiento clínico sintomático, tener el antecedente de cirugías pelvianas y las dimensiones del tumor, hacen pensar en un mesotelioma quístico benigno. Sin embargo, el carácter unilocular permite catalogarlo como un quiste mesotelial simple. La diferenciación entre ambas lesiones no es meramente académica pues el mesotelioma quístico benigno tiene una recidiva alta y puede incluso malignizarse(AU)

The simple mesothelial cyst is a rare cause of the mesenteric cysts. The size of this lessons are usually of a few centimeters andasymptomatic so the diagnosis is based on imaging studies orintra operatory findings. Clinical case: We report a female patient of 40 years old who had a simple mesothelial cyst of big size andsymptomatic, which was managed by a complete surgical excision, being this method the treatment of choice. The symptoms that thepatient described, the previous pelvic surgery and the tumor dimensions had the characteristics of a benign cystic mesothelioma. However, the unilocular characteristic allow to categorize it like asimple mesothelial cyst. The differentiation between both lessonsis not academic due to the fact that the benign cyst mesotheliomahas a high relapse and even could become a malignant lesson(AU)

Quiste mesentérico en el Instituto Nacional de Salud del Niño, Lima, Perú: reporte de caso / Mesenteric cyst in the Instituto Nacional de Salud del Niño, Lima, Peru: a case report

Los quistes mesentéricos son tumoraciones abdominales raras. Cerca de 60% de estos quistes ocurren antes de los 5 años de edad y pueden localizarse en cualquier punto del tracto gastrointestinal, aunque son mas frecuentemente encontrados en el mesenterio del intestino delgado. La presentación clínica depende de la localización y tamaño del quiste y muchos de los casos son asintomáticos y son diagnosticados incidentalmente. Los síntomas más frecuentes son dolor abdominal, distensión abdominal, masa abdominal, náuseas, vómitos, constipación, diarrea, pérdida de peso, fiebre y peritonitis. Las complicaciones incluyen torsión, infarto, formación de vólvulos, perforación, infección, anemia por hemorragia intraquística, obstrucción intestinal y uropatía obstructiva. Son típicamente tratados por escisión simple, marsupialización o resección intestinal segmentaria y tienen un excelente pronóstico a largo plazo...

Mesenteric cysts are rare abdominal tumors. About 60% of these cysts occurs before 5 years of age and can be located anywhere in the gastrointestinal tract, but are most often found in the small bowel mesentery. The clinical presentation depends on the location and size of the cyst and many cases are asymptomatic and are diagnosed incidentally. The most common symptoms are abdominal pain, bloating, abdominal mass, nausea, vomiting, constipation, diarrhea, weight loss, fever and peritonitis. Complications include torsion, infarction, volvulus formation, perforation, infection, anemia, intracystic hemorrhage, intestinal obstruction and obstructive uropathy. They are typically treated by simple excision, marsupialization or segmental bowel resection and have excellent long-term prognosis...

Diagnóstico incidental de un quiste mesentérico / Incidental diagnosis of a mesenteric cyst

Se presenta el caso de una mujer de 23 años de edad, sin síntomas específicos ni antecedentes patológicos importantes, con un diagnóstico por imágenes de dos quistes ováricos. Durante la laparotomía se encontró que un supuesto quiste de ovario resultó ser un quiste del mesenterio. Ambos quistes fueron extirpados.

This is a case of a 23 year-old female patient, with no specific symptoms and without a relevant pathological record, with a CT scan diagnosis of two ovarian cysts. Under laparotomy, it was found a mesenteric cyst misdiagnosed as an ovarian cyst. Both cysts were excised.