Cystic Intra-Abdominal Masses in Children

Abstract

Benign intra-abdominal cystic masses in infancy are fairly uncommon and their etiopathogenesis, histology and clinical presentation differ significantly. Our aim is to report our experience in their treatment in order to discuss the best diagnostic and treatment modality. The medical records of 5 children (2M, 3F) with cystic intraabdominal masses referred to our hospital between November 2012 and September 2016, were retrospectively reviewed. All patients underwent open surgery and subsequent histopathologic analysis. Different clinical presentations, localizations of the masses, diagnostic tools, surgical approaches, histological examinations and outcomes were reviewed. Patients mean age was 5.4 years (range: 8 months-9 years). Two patients presented recurrent abdominal pain and abdominal distension; 1 patient had a palpable mass discovered incidentally and 2 complained acute abdominal pain. Routine laboratory tests, tumor markers and abdominal ultrasound were immediately done in all patients. Three patients underwent MRI and 1 abdominal CT. At laparotomy 2 hepatic cysts, 2 mesenteric cyst and 1 retroperitoneal cyst were discovered. Histology reports described: 1 hepatobiliary cystadenoma, 1 benign hepatic hamartoma and 3 cystic lymphangiomas (1 retroperitoneal and 2 mesenteric). There were no major postoperative complications, deaths, or recurrences in our series (follow-up 3-24 months). Despite the rarity of these lesions, benign cystic abdominal masses in children are not so uncommon and should be considered as causes of acute abdominal pain. The differential diagnosis is not always possible preoperatively. In our series, radical excision of the lesions was possible in all cases, allowing reliable histological results and avoiding recurrences.

Imaging diagnosis of a giant choledochal cyst in an infant

“…The etiology of an abdominal mass in an infant in the order of frequency is likely to be of renal origin in 55% cases, of gastrointestinal tract origin in 15% of cases, of pelvic origin in 15% cases, adrenal masses comprise 10% of cases and a hepato-biliary origin comprises only 5% of all masses [1] . Amongst the hepatobiliary etiology of cystic abdominal masses in children, hepatic mesenchymal hamartoma, hepato-biliary cystadenoma and choledochal cysts have been reported, but are all rare [1 , 2] . A choledochal cyst is in itself a rare congenital malformation of the biliary tract and gigantic varieties of these are further rare [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] .…”

“…A choledochal cyst is in itself a rare congenital malformation of the biliary tract and gigantic varieties of these are further rare [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] . The more frequently reported gigantic abdominal cysts in children have been found to be due to mesenteric cyst, ovarian cyst in females, enteric duplication cyst and cystic lymphangioma both of intra and retroperitoneal location [1 , 2] .…”

Experience of management of abdominal cysts

“…Cystic masses in the abdomen of a child have diverse etiology but excision with concomitant restoration of functional anatomy remains the mainstay of management. 1 Though these lesions have a varied etiopathogenesis they need to be considered as close differentials due to common presentations and similar symptoms produced by these lesions. The present study highlights the experience in the management of benign intra-abdominal cysts either by exploratory laparotomy or by laparoscopic approach pertaining to the diverse etiologies associated with these lesions.…”

Gastrointestinal sistem kaynaklı konjenital nadir görülen kistik lezyonların histopatolojik değerlendirmesi

“…Kitlenin lokalizasyonu, boyutu ve komşu organlarda bası etkisine bağlı olarak; karın ağrısı, erken tokluk, bağırsak tıkanıklığı, ateş vb. bulgular görülebilir [1,2]. Fizik muayenede abdominal distansiyon ile kitle palpe edilebilir.…”

“…Sonrasında kitlelerin organlarla ilişkilerinin belirlenmesi ve detaylı incelenmesi için bilgisayarlı tomografi veya magnetik rezonans görüntüleme kullanılır [1]. Gastrointestinal sistem kaynaklı kistler; mezotelyal/omental kistler (MK), kistik lenfanjiomalar (KL), enterik duplikasyon kistleri (DK), Meckel divertikülü (MD) ve omfalomezenterik kistlerdir [1,2]. Çocuk ve yetişkinlerde nadir görülen neoplastik olmayan kitlelerdir.…”