Anti-Inflammatory Effects of Vardenafil Against Cholestatic Liver Damage in Mice: a Mechanistic Study.

BACKGROUND/AIMS: Phosphodiesterase-5 inhibitors have beneficial effects in multiple liver diseases possibly through the reduction of oxidative stress and inflammatory response. However, these effects have not yet been examined in cholestatic liver dysfunction. Hence, this study aimed to explore the ability of vardenafil, a known phosphodiesterase-5 inhibitor, to repress lithocholic acid (LCA)-induced cholestatic liver injury and investigate the possible molecular pathways. METHODS: Male Swiss albino mice were treated with LCA (0.125 mg/g) twice daily for 7 days to induce cholestatic liver damage. Vardenafil was administered 3 days before and throughout the administration of LCA. Serum markers of hepatotoxicity and hepatic nitro-oxidative stress along with antioxidant parameters were measured, and the histopathology of liver tissues was assessed. The expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and its target genes was examined using PCR. The activation of nuclear factor kappa-B (NF-κB) and the levels of inflammatory cytokines were determined. NLRP3 inflammasome and its components were studied by PCR and western blot. RESULTS: LCA induced marked cholestatic liver damage as demonstrated by increased serum transaminases, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), bilirubin, and bile acids. Examination of liver specimens confirmed the biochemical results. Nitro-oxidative stress parameters were significantly elevated along with reduced antioxidant capacity in hepatic tissue following LCA administration. LCA suppressed Nrf2 and its target genes and decreased the mRNA expression and binding capacity of Nrf2 as well as the mRNA expression of GCLm, GCLc, Nqo1, and HO-1. Additionally, LCA enhanced the activation of NF-κB, which was accompanied by elevations of inflammatory cytokines. Importantly, LCA induced the activation of NLRP3 inflammasome. LCA increased the expression of NLRP3, ASC, caspase-1, and IL-1ß genes and proteins in hepatic tissue. The activities of IL-1ß and caspase-1 were increased in the LCA group. Interestingly, vardenafil ameliorated LCA-induced hepatic injury and alleviated all biochemical, histopathological, and inflammatory parameters. CONCLUSIONS: These data elucidated the effects of Nrf2 inhibition and NLRP3 inflammasome activation in LCA-induced liver injury. The hepatoprotective activity of vardenafil in LCA-induced cholestatic damage may result from the drug's ability to activate Nrf2 signaling and prevent the activation of NLRP3, which could suppress the inflammatory responses in hepatic tissue. Thus, vardenafil can be considered a novel anti-inflammatory remedy for cholestatic liver damage.

Attitude towards donation of the excised foreskin after circumcision surgery for research: A study from Madinah, Saudi Arabia.

Studies have shown the possibility of using the part of the foreskin removed after circumcision in the field of scientific and therapeutic research. Donations of tissues and organs are always associated with ethical challenges posed by bioethicists and societies to ensure the appropriate use of these tissues/organs. The purpose of this study was to understand the attitudes and awareness of parents/guardians regarding donation of excised foreskin to research and medical use. The study was based on a questionnaire and included 133 parents/guardians who visited Uhud Children's Hospital in Madinah, Saudi Arabia for newborn male circumcision. The results showed a high willingness (61.7%) to donate the extracted foreskin to research. The willingness to donate the extracted foreskin to research associated with undergraduate degree (P = 0.018), male sex (P = 0.011), high income (P = 0.029), and participation in previous research studies (P = 0.002). About 41.8% were convinced that written informed consent should be obtained before circumcision surgery, 38.1% (n = 51) were convinced that written informed consent should be taken after surgery, while the remaining 19.4% reported that the timing of written informed consent is unimportant. Finally, fear of excision of excess tissue (74.5%), lack of confidence in the research (68.6%), and potential for commercial use (64.7%) were the main barriers to unwillingness to donate the excised foreskin for research. In conclusion, a reasonable portion of Saudis agreed to donate their foreskin for research purposes. There is an urgent need to enhance awareness and attitudes towards tissue donation for research and therapeutic use.

Risk factors associated with anorectal malformations development. A case-control study.

OBJECTIVES: To determine the risk factors for the development of anorectal malformations (ARM). Methods: This case-control study was conducted in the Maternity and Children Hospital (MCH), Al Madinah Al Munnawarah, Saudi Arabia. The sample was taken from the ARM cases admitted at MCH between January 2013 and December 2017. The controls were selected from well-baby clinics in primary health care centers. Parents of the cases and the controls were interviewed based on a questionnaire. Descriptive, univariate, and multivariate logistic regression were used in the analysis. Results: The study included 48 cases and 96 controls with 31 (64.6%) cases of isolated ARM and 17 (35.4%) cases of associated ARM. Among the ARM cases, 27 (56.3%) were males and 21 (43.8%) were females. In multivariate analysis, we found consanguinity to be associated with an increased risk of developing ARM with odds ratio (OR): 2.43, 95% CI: 1.12-5, and p=0.025, in addition to maternal obesity, with OR: 4.36, 95% CI: 1.2-15.8, and p=0.025. Conclusion: Consanguinity and maternal obesity (body mass index more than 30) were found to be risk factors for ARM development.

The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis.

BACKGROUND: The association between macrolides use and subsequent occurrence of infantile hypertrophic pyloric stenosis (IHPS) is still debatable. The aim of this study was to conduct a systematic review and meta-analysis of the association between perinatal exposure to macrolides, mainly erythromycin, and the development of pyloric stenosis. METHODS: Original studies were identified using MEDLINE, Web of Science, Scopus, Google Scholar, and the Cochrane Library databases. Studies investigating the association between perinatal exposure to macrolides and pyloric stenosis were included. The most adjusted effect estimates were pooled using random-effects meta-analysis. The I2 and Egger's tests were used to assess heterogeneity and publication bias, respectively. RESULTS: Fourteen papers (12 retrospective cohort studies and two case-control studies) were included. For postnatal exposure, the overall estimate of seven cohort studies indicated a statistically significant association (RR = 3.17, 95% CI: 2.38-4.23; I2 = 10.0%) with no evidence of publication bias (Egger P = 0.81). For prenatal exposure, six cohort studies and two case-control studies were included. Meta-analysis demonstrated a statistically significant association in the cohort studies (OR = 1.47, 95% CI: 1.03-2.09; I2 = 29.3%), but not in the case-control studies (OR = 1.02, 95% CI: 0.66-1.58; I2 = 51.2%). The overall pooled result was not statistically significant. Only two studies were included for exposure through breastfeeding, and the estimates did not show a statistically significant association (OR = 1.31; 95% CI: 0.42-4.1; I2 = 69.1%). CONCLUSIONS: The study demonstrated good evidence of association between development of IHPS and direct postnatal exposure to macrolides. However, the evidence on the effects of prenatal exposure or postnatal maternal exposure (breastfeeding) is not conclusive.

Dichloroacetate is an antimetabolite that antagonizes acetate and deprives cancer cells from its benefits: A novel evidence-based medical hypothesis.

Dichloroacetate (DCA) is a promising safe anticancer drug that cured a patient with chemoresistant non-Hodgkin's lymphoma and treated lactic acidosis effectively. The well-known mechanism of DCA action is through stimulating Krebs cycle (stimulating pyruvate dehydrogenase via inhibiting pyruvate dehydrogenase kinase). This prevents lactate formation (Warburg effect) depriving cancer cells of lactate-based benefits e.g. angiogenesis, chemoresistance and radioresistance. Here, we introduce novel evidence-based hypotheses to explain DCA-induced anticancer effects. On pharmacological and biochemical bases, we hypothesize that DCA is a structural antagonist of acetate competing with it for target enzymes and biological reactions. We hypothesize that DCA exerts its anticancer effects via depriving cancer of acetate benefits. We hypothesize also that acetate is an antidote of DCA capable of treating DCA toxicity. Many reports support our hypotheses. Acetate is vital for cancer cells (tumors depend on acetate) and DCA is structurally similar to acetate. DCA exerts opposite effects to acetate. Acetate caused a decrease in serum potassium, phosphorus and glucose, and an increase in serum lactate, citrate, free fatty acids and ketone bodies (serum acetoacetate and beta-hydroxybutyrate levels). Acetate decreased the proportion of active (dephosphorylated) pyruvate dehydrogenase in perfused rat heart. DCA produced quite opposite effects. Intravenous infusion of acetate produced metabolic alkalemia while DCA caused minimal effects on acid-base status. Acetate is important for cancer cells metabolism and survival as elevated acetate can drive resistance to targeted cancer treatments. Acetate is required for epidermal growth factor receptor vIII mutation in lethal brain tumors. Experimentally, DCA inhibited acetate oxidation in hearts of normal rats and reversed inhibitory effects of acetate on the oxidation of glucose. During presence of DCA with no glucose in heart perfusions with [1-14C]acetate, DCA decreased the specific radioactivity of acetyl CoA and its product citrate. This proves our hypotheses that DCA is an antimetabolite that antagonizes acetate for vital reactions in cancer cells. Acetate may be used as an antidote to combat DCA toxicity.

Surgical practice among pediatric surgeons and pediatric urologists in the Kingdom of Saudi Arabia for the management of suspected testicular torsion.

OBJECTIVES: To review and compare clinical practice and experience among pediatric surgeons (PS) and pediatric urologists (PU) for the management of testicular torsion (TT) in the Kingdom of Saudi Arabia (KSA). METHODS: This was a cross-sectional study conducted between August 2016 and November 2017, among all PU and PS involved in the management of suspected TT in KSA. A questionnaire was distributed to participants through the Survs.com platform, and direct email when requested by participant. Results: Most PU (12/20, 60%) utilized ultrasound with Doppler before exploration, while 29 (74.4%) PS performed immediate exploration without imaging, representing a statistically significant difference (p=0.03). When the explored testis was dusky (not frank gangrenous), 27 PS (69.2%) performed fixation, 6 (15.4%) followed the second look policy, and 6 (15.4%) performed orchiectomy. With respect to PU, 6 (30%) performed fixation, 8 (40%) followed the second look policy, and 6 (30%) performed orchiectomy. The differences between the 2 specialties were statistically significant (p=0.02). Most consultants in both specialties performed fixation of the contralateral testis during the same operation. Also, there is a variation in practice when there is other pathology than TT. Conclusion: There were significant variations between the 2 specialties in the management of TT. National guidelines are needed to provide homogenous clinical practice and training of trainees.

Hepatopulmonary fusion associated with right-sided congenital diaphragmatic hernia: management of this rare anomaly and a review of the literature.

Hepatopulmonary fusion is a rare malformation that is often discovered during operative repair of right-sided congenital diaphragmatic defects. Based on a search using medical search engines, we only found 22 cases of hepatopulmonary fusion in the English literature worldwide to date. We describe herein a case of hepatopulmonary fusion with right-sided congenital diaphragmatic hernia in a female neonate who presented with respiratory distress. We discuss management of this case and review the relevant literature.

Mapping the factors that influence the career specialty preferences by the undergraduate medical students.

It is often perceived that undergraduate medical students do not select their career specialty until they are graduated. This study aimed to probe the preferences of undergraduate medical students about their career specialty and the factors influencing their choices. A self-administered questionnaire was distributed to 3rd through 5th year undergraduate medical students to record their choices of specialties and to identify the factors that influence their career selection. Out of 220 respondents, 29 (13.2%) students selected General Surgery, 24 (10.9%) Pediatrics, and 18 (8.2%) Internal Medicine as their career specialties; whereas 24 (10.9%) students were not able to select a major specialty. The least popular specialties were Gynecology and Obstetrics, Oncology, Histopathology, Orthopedics, Genetics, Psychology, each selected by one student. One hundred and seventeen (53.1%) thought their selected specialty 'matched their capabilities' and 82 (37.2%) perceived their selection as "innovative field in medicine". Career advice by friends and families and the desire to serve academic institutions could not influence career selection. Career preferences by medical students result from the interplay of a range of factors. General Surgery, Pediatrics and Internal Medicine were the most preferred specialties. The professional grooming programs to target specialties matching the trainees' capabilities and the specialties with state-of-the-art innovative technologies attract medical undergraduate students. The attained knowledge is vitally important for the policy makers in modifying the existing framework that can cater the popular and favored specialties.

Pristimerin as a Novel Hepatoprotective Agent Against Experimental Autoimmune Hepatitis.

Pristimerin (Pris) is bioactive natural quinonoid triterpene that has anti-inflammatory and anti-cancer activities. Meanwhile, its effect against hepatitis needs to be elucidated. This investigation aimed to evaluate the ability of Pris to protect against autoimmune hepatitis (AIH). A mouse model of AIH was established using single concanavalin A (Con A) intravenous injection. Mice were treated with Pris at two different doses (0.4 and 0.8 mg/kg) for 5 days prior to Con A challenge. Markers of hepatic injury, oxidative, inflammatory, and apoptotic damage were estimated. Results have revealed that Pris pretreatment ameliorated Con A-induced hepatic damage. There was decrease in the elevated serum indices of hepatic damage (ALT, AST, ALP, and LDH) and improvement of the histopathological picture of the liver. Pris effectively decreased Con A-induced neutrophil infiltration into the hepatic tissue as presented by amelioration of the level and immuno-expression of myeloperoxidase (MPO). Additionally, Pris attenuated Con A-induced increase in CD4+ T-cells in hepatic tissue. Lipid peroxidation was significantly depressed simultaneously with enhancement of the antioxidant capacity in Pris pretreated animals. Pris also enhanced nuclear factor erythroid 2-related factor 2 (Nrf2) mRNA expression and its binding capacity. In addition, Pris increased mRNA expression of heme-oxygenase-1 (HO-1) and restored its normal level. Furthermore, Pris decreased the level and immuno-expression of nuclear factor kappa-B (NF-κB) as well as the downstream inflammatory cascade (TNF-α, IL-6, and IL-1ß). Finally, Pris showed inhibitory effect on Con A-induced apoptotic alteration in liver as it decreased the mRNA expression and levels the apoptotic markers (Bax and caspase-3) and increased mRNA expression and level of the anti-apoptotic protein (Bcl2). In conclusion, this study demonstrates the potent hepatoprotective efficacy of Pris against Con A-induced hepatitis which may be related to anti-oxidative, anti-inflammatory, and anti-apoptotic pathways. Pris could serve as a new candidate for the management of hepatitis.

Al-hijamah (wet cupping therapy of prophetic medicine) significantly and safely reduces iron overload and oxidative stress in thalassemic children: a novel pilot study.

BACKGROUND: Thalassemia is a major health problem due to iron overload, iron deposition and oxidative stress-induced tissue damage. Here, we introduce Al-hijamah (a minor surgical excretory procedure) as a novel percutaneous iron excretion therapy. Al-hijamah is a wet cupping therapy of prophetic medicine, and prophet Muhammad, peace be upon him, strongly recommended Al-hijamah, saying: "The best of your treatment is Al-hijamah". AIM OF THE STUDY: Our study aimed at investigating the safety, iron chelation, pharmacological potentiation and oxidant clearance effects exerted by Al-hijamah to thalassemic children. PATIENTS AND METHODS: Ethical committee's approval and patients' written agreement consents were obtained. We treated 20 thalassemic children (15 males and five females aged 9.07±4.26 years) with iron chelation therapy (ICT) plus Al-hijamah (using sterile disposable sets and in a complete aseptic environment) vs a control group treated with ICT only. This clinical trial was registered in the ClinicalTrial.gov registry under the name "Study of the Therapeutic Benefits of Al-hijamah in Children with Beta Thalassemia Major" (identifier no NCT 02761395) on 30 January 2016. RESULTS: Al-hijamah was quite simple, safe, effective, tolerable (with no side effects) and time-saving procedure (30-60 minutes). A single session of Al-hijamah significantly reduced iron overload (P<0.001) in all thalassemic children. Al-hijamah significantly decreased serum ferritin by 25.22% (from 3,778.350±551.633 ng/mL to 2,825.300±558.94 ng/mL), significantly decreased oxidative stress by 68.69% (P<0.05; serum malondialdehyde dropped from 42.155±12.42 to 13.195±0.68 nmol/L), exerted pharmacological potentiation to ICT and significantly increased total antioxidant capacity (P<0.001) by 260.95% (from 13.195±0.68 nmol/L to 42.86±12.40 nmol/L through excreting reactive oxygen species). Moreover, therapeutic indices for evaluating Al-hijamah were promising. CONCLUSION: Al-hijamah is a novel, safe, effective percutaneous iron excretion therapy through percutaneous iron excretion with minimal blood loss in agreement with the evidence-based Taibah mechanism. Al-hijamah is an effective outpatient hematological procedure that is safer than many pediatric procedures such as catheterization, hemofiltration and dialysis. Increasing the number of cups during Al-hijamah session or the number of sessions reduces iron overload more strongly. Medical practice of Al-hijamah is strongly recommended in hospitals.

The promising anticancer drug 3-bromopyruvate is metabolized through glutathione conjugation which affects chemoresistance and clinical practice: An evidence-based view.

3-Bromopyruvate (3BP) is a promising effective anticancer drug against many different tumors in children and adults. 3BP exhibited strong anticancer effects in both preclinical and human studies e.g. energy depletion, oxidative stress, anti-angiogenesis, anti-metastatic effects, targeting cancer stem cells and antagonizing the Warburg effect. There is no report about 3BP metabolism to guide researchers and oncologists to improve clinical practice and prevent drug resistance. In this article, we provide evidences that 3BP is metabolized through glutathione (GSH) conjugation as a novel report where 3BP was confirmed to be attached to GSH followed by permanent loss of pharmacological effects in a picture similar to cisplatin. Both cisplatin and 3BP are alkylating agents. Reported decrease in endogenous cellular GSH content upon 3BP treatment was confirmed to be due to the formation of 3BP-GSH complex i.e. GSH consumption for conjugation with 3BP. Cancer cells having high endogenous GSH exhibit resistance to 3BP while 3BP sensitive cells acquire resistance upon adding exogenous GSH. Being a thiol blocker, 3BP may attack thiol groups in tissues and serum proteins e.g. albumin and GSH. That may decrease 3BP-induced anticancer effects and the functions of those proteins. We proved here that 3BP metabolism is different from metabolism of hydroxypyruvate that results from metabolism of D-serine using D-amino acid oxidase. Clinically, 3BP administration should be monitored during albumin infusion and protein therapy where GSH should be added to emergency medications. GSH exerts many physiological effects and is safe for human administration both orally and intravenously. Based on that, reported GSH-induced inhibition of 3BP effects makes 3BP effects reversible, easily monitored and easily controlled. This confers a superiority of 3BP over many anticancer agents.

Indicators for surgical intervention in thoracic empyema in children.

OBJECTIVES: To determine predictors for surgical intervention of thoracic empyema in children, and its associated morbidity. METHODS: We conducted a retrospective review of medical records of children with empyema thoracis admitted in the Maternity and Children Hospital, Al Madinah Al Munawwarah, Saudi Arabia between January 2007 and January 2012. The data extracted included: socio-demographic data, clinical data, method of treatment, and follow up data. According to the introduced therapeutic methods, a total of 62 patients were divided into 2 groups; patients treated with chest tube (CT) insertion (51 cases), and 11 cases that required thoracotomy (TH); groups were compared to determine predictors for thoracotomy. RESULTS: Of 62 patients, 37 were females and 25 were males. In terms of age, side of lesion, presence of cough, or dyspnea, both groups were homogenous. Both groups had significant differences for duration of complaint (TH and CT) (13.5±6.5 days versus 10±3.6, p=0.005), presence of fever (90.2% versus 36.4%, p less than 0.001), history of recurrent chest infections (90.9% versus 37.3%, p=0.001), and radiological findings. However, it was not evident that any of these variables influenced treatment decision except absence of fever, which was significantly less in patients treated with thoracotomy. CONCLUSION: No specific indicator was found to increase expectancy for surgical intervention as a treatment choice, except the absence of fever, which may reflect the delayed referral and prolonged use of antibiotics and cannot be interpreted truly without caution as an indicator for surgical intervention.

Incidence and spectrum of anorectal malformations in Western Saudi Arabia.

OBJECTIVE: To present the incidence and spectrum of anorectal malformations (ARMs) and associated anomalies, and to compare the findings with published literature. METHODS: This is a retrospective study conducted during the period January 2011 to December 2011. We reviewed the medical charts of all cases with ARMs admitted to Al-Madinah Maternity and Children Hospital, Madinah, Kingdom of Saudi Arabia during 1998-2010. The incidence and spectrum of ARMs, associated regional anomalies, and those with a positive family history of ARMs were identified. The 95% confidence interval and Chi square trend test were used to quantify the significance of variation in annual incidence. RESULTS: One hundred and eighty-eight cases of ARMs were detected from 189,145 live births with an incidence of approximately 1/1000 live births with a male-to-female ratio of 1.9:1. The incidence showed yearly stability (p=0.3509). The most common ARMs was perineal fistula (32.9%). There was a statistically significant gender difference (p=0.000). The most common in boys was rectourethral fistula (47.2%) and in girls was vestibular fistula (46.2%). Isolated non-familial ARMs was found in 106 (56.3%), isolated familial 9 (4.7%), and associated ARMs in 73 (38.8%) cases. In terms of associated anomalies, genitourinary (34%), and cardiovascular (19.2%) systems reported a high incidence. CONCLUSION: The incidence of ARMs in Madinah Kingdom of Saudi Arabia, is higher than the reported data. Isolated ARMs was more common than the associated category, and the familial one was rarely reported.

Small group teaching improves students` acquisition of knowledge and skills.

OBJECTIVE: To evaluate the effectiveness of small group teaching (SGT) in improving the undergraduate medical students` knowledge and skills. METHODS: This study took place at the College of Medicine, Taibah University, Madina, Kingdom of Saudi Arabia between September 2011 and September 2012. Small group teaching was applied by the surgery department. In this prospective study, fifth year students were divided into groups of 8 students, and teaching strategies of SGT were applied. The marks in the clinical examinations of long case and objective structured clinical examination (OSCE) of the students with a traditional teaching cohort of 2010-2011 were compared to a SGT cohort of 2011-2012. Data were analyzed by comparing the means, standard error, and standard deviation. RESULTS: One hundred and sixty-four students were incorporated, 82 students for each year (41 males and 41 females) in each group. The analysis showed a statistical significant difference in marks obtained by male and female students of both cohorts (p=0.000). In the 2011-2012 group, male students` mean score was 43.1+/-2.99 which was higher than the 2010-2011 male students` (mean+/-SD: 38.7+/-2.81; p=0.000). Similarly, the 2011-2012 female students attained a higher mean score than those in the 2010-2011 (39.8+/-4.0 and 35.6+/-3.88) (p=0.000). CONCLUSION: Small group teaching is a valuable strategy in enhancing students` performance in the clinical settings. Small group teaching can be applied to other clinical disciplines of the medical curriculum for production of safe and clinically competent graduates.

Laparoscopic reduction of intussusception in children: role in primary and revisional reduction after failed non-surgical therapies.

BACKGROUND AND OBJECTIVE: With the advent of laparoscopy into pediatric surgical filed and with experience gaining, as well as, improvement in instrumentation, it has been used in management of different conditions, including intussusception. However, there is no universal acceptance regarding its role in reduction of intussusception. This is due to the early reports of high conversion rate and the concern of missing a lead point. The aim of this article is to review the literatures about safety and efficacy of laparoscopy in intussusception management and the limitations as well as formulating a working algorithm for management of intussusceptions in pediatric age group up to 18 years. Up to my knowledge this is the first review article in this subject. METHOD: A comprehensive review of the English literature in Pub Med searching engine was conducted with key words laparoscopy, intussusception, management of intussusception, minimal invasive surgery and intussusception, laparoscopic reduction of intussusception, between 1996 and2009 .The results yielded were further explored for citation regarding the role of laparoscopy in reduction of intussusception. RESULTS: The success rate increased from 57% in 1997 to 91% in 2009 while the conversion rate decreased from 43% in 1997 to 9% in 2009.The presence of a lead point and/or ischemic bowel were the main reasons for conversion in the initial reports. CONCLUSION: Laparoscopy is a safe and efficient method for reduction of intussusception. The presence of a lead point or necrotic bowel is no more indication for conversion to open surgery. Laparoscopy should be an integral tool in the management algorithm of intussusception.

Giant mesenteric cyst.

Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis is established only during surgery or histological analysis. The treatment of choice is complete surgical excision. We report an 18-year-old female with a non-specific abdominal pain and discomfort since 3 weeks. Her CT scan showed a huge cystic swelling, which necessitated surgical exploration. Preoperatively, a giant cyst was encountered with displacement of bowel loops. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy.