Pediatric chylolymphatic mesenteric cyst - a separate entity from cystic lymphangioma: a case series

Abstract

IntroductionChylolymphatic mesenteric cysts are rare entities with variable presentations and this has surgical implications in the pediatric age group.Case presentationWe carried out a retrospective analysis of the clinical and histopathological records of pediatric patients diagnosed and treated for chylolymphatic mesenteric cysts at our institute from 1998 to 2008. Eight patients met the histopathological criteria of chylolymphatic mesenteric cyst. These patients were in the age range 18 months to 10 years with a mean age of 4.5 years. Of these eight patients, four presented with an abdominal lump, and two each with abdominal pain and acute intestinal obstruction. On clinical examination, five out of the eight patients had a palpable abdominal mass. Laparotomy and complete excision of the cyst along with the involved gut was performed in all patients. There were no postoperative complications or any recurrence during the follow-up period which ranged from 4 months to 8 years.ConclusionAlthough very rare, chylolymphatic mesenteric cyst should be kept in mind as one of the differential diagnoses of cystic masses of the abdomen including cystic lymphangioma. Ultrasonography and computed tomography suggest the diagnosis but histopathological examination is required for confirmation. Complete excision of the cyst yields excellent results.

Chylolymphatic Cyst of Mesentery of Terminal Ileum: A Case Report in 8 Year-old Boy

“…Mesenteric cysts may cause acute abdomen from the cyst rupture, infection, hemorrhage, intestinal obstruction, and volvulus [1][2][3][4][5][6][7][8][9]. USG and computed tomography scan of the abdomen are the investigations of choice and may helpful in the pre-operative diagnosis of mesenteric cysts, but not possible to confirm it in all the case [2,[4][5][6]9]. Mesenteric cysts may vary in size from 4 cm to 30 cm [3,8].…”

“…Other cystic lesions in the abdomen that resemble mesenteric cysts are cystic lymphangioma (hygroma), cystic teratoma, ovarian cyst, intestinal duplication cyst, hydatid cyst, etc [1,9]. The pathological features of these cysts can vary considerably.…”

“…Mesenteric cysts are most commonly single and multilocular and the fluid are generally serous when the cyst involves the distal small bowel or colonic mesentery and chylous when it is located in the proximal small bowel mesentery [1]. Histopathological examination is confirmatory and differentiates chylolymphatic cysts from all these lesions [1,9].…”

“…Complete surgical excision remains the mainstay for the treatment of the mesenteric cysts with an excellent result [1][2][3][4][5][6][7][8][9]. In approximately 20% to 60% of the cases bowel resection and anastomosis is needed along with the excision of the mesenteric cysts [2,[4][5][6]8].…”

“…All of these cases were multiloculated and localized at the mesentery of the small intestine with a maximum size of 9 cm. All the cases were confirmed on histological examination as chylolymphatic cysts, and there were no recurrence [9]. The recurrence following complete excision of the mesenteric cyst is very rare, but may occur [8].…”