Mesenteric Cyst - Classification, Symptoms, Diagnosis, and Treatment

What Is a Mesenteric Cyst?

The mesentery is a fold of tissue that attaches the bowel to the abdomen. A benign (non-cancerous) mass arising from the mesenteric tissue in the abdomen is referred to as a mesenteric cyst. It may be asymptomatic and is incidentally diagnosed during routine imaging techniques. It is characterized by single or multiple fluid-containing cysts of varying sizes. It also presents as unilocular (single cavity) or multilocular (multiple cavities) that develop in any part of the gastrointestinal (GI) tract from the small to the large bowel.

How Common Is a Mesenteric Cyst?

A mesenteric cyst is an uncommon condition. It affects one in 100,000 adult population and one in 20,000 children. Women and children below 15 are more commonly affected than men. Benivieni, an Italian anatomist, first reported it in 1507. Tillaux, in 1880 carried out the first successful surgery on a mesenteric cyst.

What Causes a Mesenteric Cyst?

The main factor that predisposes the formation of a mesenteric cyst is not known. However, the following elements are found to cause a mesenteric cyst.

• Blockage of lymphatic drainage: When the lymphatic vessels are hindered, the drainage of lymphatic fluid is interrupted, leading to the formation of cysts. It occurs as a result of trauma, infections, or neoplasms.

• According to Gross, the cells remnants of the lymphatic system during development are transmitted to the mesentery to form a cyst. It lacks connection with other lymphatic systems.

How Is a Mesenteric Cyst Classified?

In 1880, DePerrot et al. classified the mesenteric cyst based on the microscopic examination (histopathology) as follows:

• Cyst of Lymphatic Origin is the most common type and is a single and unilocular cyst. The lymphatic cyst is usually in the small bowel and has a blood supply.

• Cyst of Enteric Origin - It develops as a duplication of the nearby bowel and gets blood supply from it. About 3% of enterogenous types are found to turn cancerous. However, it is challenging to diagnose such cysts due to a lack of specific symptoms.

• Cyst of Urogenital Origin - The mesenteric cyst arises from the remnants of urinary and genital tissues during development.

• Cyst of Mesothelial Origin - The mesenteric cyst is single and unilocular.

• Mature Cystic Teratoma - The cyst comprises mature tissues and rarely presents as a mesenteric cyst.

• Pseudocyst - It includes the infectious and traumatic cyst.

What Are the Signs and Symptoms?

The mesenteric cyst usually does not produce any symptoms. However, the following are observed in a few individuals.

• Abdominal pain.

• Palpable abdominal mass.

• Swollen abdomen.

• Nausea.

• Vomiting.

• Constipation.

• Diarrhea.

How to Diagnose a Mesenteric Cyst?

• Clinical Examination: The doctor examines the abdomen to determine the characteristic features of a mesenteric cyst, such as swelling, pain, and the presence of a palpable mass.

• Blood Examination: It is done to evaluate the blood cell count and electrolyte levels. It is usually expected in individuals with the mesenteric cyst and does not aid in definitive diagnosis.

• Ultrasound: Ultrasonography (USG) of the abdomen helps detect the fluid-filled cyst, and the imaging findings often resemble a large ovarian cyst. The cyst of enteric origin presents with a thick wall adjacent to the bowel loops.

• Computed Tomography (CT): Contrast agents are administered orally or intravenously to examine the intra-abdominal organs and to detect the presence of abnormal lesions. It aids in determining the accurate size and location of the cyst. The imaging is usually done preoperatively to assist in surgical procedures.

What Are Related Disorders?

The conditions that possess similar characteristics to mesenteric cyst are listed below:

• Ovarian Cyst - Ovaries are present on both sides of the uterus, and the fluid-filled sacs within it are referred to as ovarian cysts. It usually occurs due to improper rupture of follicles inside the ovaries to release the egg. As a result, the affected woman presents with abdominal fullness and pelvic pain. Pelvic ultrasound is used to diagnose such cysts.

• Hydronephrosis - When the tubes that excrete urine are blocked, it accumulates in the kidneys and causes swelling. It can occur at any age and causes lower abdominal pain, nausea, and vomiting. Ultrasound imaging helps in determining any obstruction in the urinary tract.

• Hydrometrocolpos - The build-up of vaginal secretions that leads to the swelling of the uterine cavity is known as hydrometrocolpos. The abnormal hormone production in mothers causes the accumulation of secretions in the baby’s vagina during the intrauterine life.

• Peritoneal Hydatidosis - The disease occurs due to the rupture of a hydatid cyst in the liver. On clinical examination, the abdominal distention, pain, and palpable mass are similar to the mesenteric cyst. However, imaging techniques are used to differentiate both.

What Are the Complications?

• Volvulus: The condition is characterized by abnormal rotation of bowel loops around it and the mesentery. It leads to abdominal pain, swelling, and constipation due to bowel obstruction. Immediate surgical treatment is required to prevent its progression.

• Intestinal Obstruction: The presence of a large cyst in the bowel obstructs the passing of food through the intestine and thus leads to abdominal swelling and infection.

• Bowel Hernia: The bulging of the intestinal part into the abdomen due to compression by the cyst also occurs.

• Infection: The fluid leakage from the mesenteric cyst causes the spread of disease to the bloodstream.

• Cystic Rupture: The giant mesenteric cyst ruptures and causes severe pain and internal bleeding.

How Is Mesenteric Cyst Treated?

The mesenteric cyst cannot subside with any medications. Therefore, the appropriate management involves completely removing the cyst to prevent its recurrence and avoid its malignant transformation.

• Total Cystectomy: The complete removal of cyst and bowel, if needed, is done through the open method. It is mainly preferred as it reduces the recurrence rate.

• Laparoscopic Excision: The surgeon also excises the cyst through a small incision in the abdomen with the aid laparoscope (thin rod with a camera on its end). The complications and recovery time are less in laparoscopic surgery.

Conclusion:

Mesenteric cyst rarely occurs in children and adults. It poses a significant challenge to the specialist in diagnosing and treating such conditions. Complete surgical cyst removal is essential to prevent its further complication and recurrence. A good prognosis is achieved after surgical treatment of mesenteric cysts. Therefore, it is vital to consult a gastroenterologist to identify the cause of abdominal swelling and pain.