Mesenteric Cyst – Omental Cyst
It is an uncommon condition in Pediatric Surgery practices. It has been reported that it is seen in every 20,000-25,000 children in children’s hospitals. It can also be seen in adults, but almost one third of cases are seen under the age of 15. It is mentioned that it is more common in girls.
They are called mesenteric cysts because they are located in a fatty tissue containing the blood and lymph vessels of the intestines called mesentery. There may also be cystic formations in the fat tissue called the omentum, which is in this region and covers the intra-abdominal organs. Also, lymphangiomas, known as cystic enlargement of lymphatic vessels originating from lymphatic tissue, are also found in this region. Sometimes these three can be confused with each other. These three should always be kept in mind in the differential diagnosis.
Usually these cysts are detected incidentally. The patient comes to the pediatric surgeon with the diagnosis made. In some cases, excessive growth of the cyst may occur. This overgrowth may be too large to be noticed from the outside. Intestinal obstructions due to this growth, and the effect of the mass, can manifest itself with an emergency picture that occurs with the rotation of the intestines around their own vessels, called volvulus. In this case, sudden onset of abdominal pain, bilious vomiting, bloody stools can be seen.
The cause is unknown. Many embryological theories have been put forward about how they develop. Mesenteric cysts can be observed anywhere from the duodenum to the rectum, the closest part of the digestive system to the anus.
These cysts usually do not regress, they can grow. As I mentioned above, it can also cause intestinal obstructions. It has been reported that 3% of these cysts, which are of embryological origin, can also transform into malignant tumors.
After diagnosis, surgical removal is recommended. If they are not removed, the problems I mentioned above may be encountered. The goal of surgical treatment is the complete removal of this cyst. In some cases, the cyst becomes so attached to the intestines that it may be necessary to remove part of the intestines together. It is an operation that can be performed by laparoscopic surgical methods among pediatric surgery applications. The obvious advantages of laparoscopic surgery in this disease are; It is cosmetically superior, less post-operative pain, and faster post-operative recovery time. Unfortunately, laparoscopic surgery applications have not become widespread in the field of pediatric surgery in our country.
If there is insufficient removal after surgery, recurrence may occur. The probability of recurrence is reported at different rates in different series. However, it is possible to talk about a risk of around 5% on average.
