Management of Mesenteric Cysts in Children: Review of Ten Cases PC05-PC09
Dr. Rajendra Kumar Ghritlaharey,
Professor and Head, Department of Pediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal-462001, Madhya Pradesh, India.
Introduction: Mesenteric cysts are rare, benign, intra-abdominal entities with diverse clinical presentation, and most frequently located in the mesentery of the small bowel. Complete excision of the mesenteric cysts is a therapy of choice, although more than 50% require bowel resection and anastomosis during complete excision.
Aim: To review the clinical presentation, and management of mesenteric cysts in children.
Materials and Methods: During Jan 2000 to Dec 2016, 10 children with mesenteric cysts under the age of 12-years were treated by author at Department of Paediatric Surgery. Desired data was obtained from case sheets. The intention was to review their clinical presentation, diagnostic modalities used, and results of surgical excision done for mesenteric cysts.
Results: This retrospective review of the management of mesenteric cysts included six boys and four girls. The mean age at the time of presentation was 43.6±26.84 months, and ranged from 2 to 96 months. Seven of them presented with acute intestinal obstruction, and remaining three presented with abdominal lump and abdominal pain. Mesenteric cysts involved the jejunum in six, and ileum was involved in remaining four cases. Surgical procedures executed in order of frequency were: (a) en bloc excision of mesenteric cysts, part of involved jejunum and jejuno-jejunal anastomosis n=5; (b) en bloc excision of mesenteric cysts, part of involved ileum and ileoileal anastomosis n=2; (c) complete excision of mesenteric cyst and repair of mesenteric defects n=2; and (d) en bloc excision of mesenteric cyst, part of involved ileum, and an ileostomy which was closed 2 and half months later n=1. Histologically, all of them were reported as mesenteric cysts. Recurrence was not noted in follow up period, which ranged from 6-months to 2-years.
Conclusion: Mesenteric cysts are rare, benign, intra-abdominal pathology in children, and most of them present as an acute intestinal obstruction. In the study, volvulus of the small intestine due to mesenteric cysts was observed in 70% of the cases. Bowel resection was also required in 80% of the cases during surgical excision of the mesenteric cysts.