eMedicine Specialties > Pediatrics: Surgery > General Surgery

Mesenteric and Omental Cysts: Workup

Author: Amulya K Saxena, MD, Attending Pediatric Surgeon, Department of Pediatric Surgery, Medical University of Graz, Austria
Contributor Information and Disclosures

Updated: Jan 16, 2008

Workup

Laboratory Studies

  • No specific laboratory studies aid in the diagnosis of mesenteric and omental cysts.

Imaging Studies

  • Radiography
    • Plain abdominal radiography may reveal a gasless, homogeneous, water-dense mass that displaces bowel loops laterally or anteriorly in the presence of a mesenteric cyst or posteriorly in the presence of an omental cyst.8,21
    • Fine calcifications can sometimes be observed within the cyst wall.13,24,25
  • Ultrasonography
    • The imaging modality of choice is abdominal ultrasonography.11,15,16,25 Ultrasonography reveals fluid-filled cystic structures, commonly with thin internal septi and sometimes with internal echoes from debris, hemorrhage, or infection.9,16,25 However, these can be confused with large ovarian cysts in the fetus and newborn.
    • Enteric duplication cysts, on the other hand, are thick-walled structures that share a common muscular wall with the adjacent bowel. They also have a clearly visible mucosal lining on ultrasonography.22
  • CT scanning
    • Abdominal CT scanning adds minimal additional information, although it can reveal that the cyst is not arising from another organ such as the kidney, pancreas, or ovary.7
    • Radionuclide scanning of the biliary tract excludes choledochal cysts from diagnostic consideration.22

Other Tests

  • No other tests are necessary.

Diagnostic Procedures

  • No further diagnostic procedures are necessary.

Histologic Findings

Cystic lymphangiomas are sometimes differentiated from mesenteric and omental cysts.6,9,15 Cystic lymphangiomas have an endothelial cell lining, foam cells, and thin walls that contain lymphatic spaces, lymphoid tissue, and smooth muscle. Mesenteric cysts lack smooth muscle and lymphatic spaces, and the cells lining the cysts are cuboidal or columnar in nature.6 Lymphangiomas are more diffuse and occur in the mesentery or retroperitoneum, and patients may present earlier in life than those with mesenteric or omental cysts.6,15 In a series of 191 patients with lymphangioma, 4.7% of patients presented with lymphangioma in the mesentery.26

For the purposes of this discussion, a mesenteric cyst is defined as any cyst that is located in the mesentery and may or may not extend into the retroperitoneum; a mesenteric cyst also has a recognizable lining of endothelial or mesothelial cells. An omental cyst has the same histologic characteristics but is confined to the greater or lesser omentum.22

More on Mesenteric and Omental Cysts

Overview: Mesenteric and Omental Cysts
Workup: Mesenteric and Omental Cysts
Treatment: Mesenteric and Omental Cysts
Follow-up: Mesenteric and Omental Cysts
Multimedia: Mesenteric and Omental Cysts
References
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References

  1. Mohanty SK, Bal RK, Maudar KK. Mesenteric cyst--an unusual presentation. J Pediatr Surg. May 1998;33(5):792-3. [Medline].

  2. von Rokitansky CF. Handbuch der pathologischen anatomie, bd2 Handbuch der Speciellen Pathologischen Anatomie. Wein: Braumuller & Seidel; 1842.

  3. Gairdner WT. A remarkable cyst in the omentum. Trans Path Soc Lond. 1852;3:1851.

  4. Tillaux PJ. Cyste du mesentere un homme: ablation par la gastromie: quersion. Revue de Therapeutiques Medico-Chirurgieale Paris. 1880;47:479.

  5. Kurtz RJ, Heimann TM, Holt J, Beck AR. Mesenteric and retroperitoneal cysts. Ann Surg. Jan 1986;203(1):109-12. [Medline]. [Full Text].

  6. Takiff H, Calabria R, Yin L, Stabile BE. Mesenteric cysts and intra-abdominal cystic lymphangiomas. Arch Surg. Nov 1985;120(11):1266-9. [Medline].

  7. Vanek VW, Phillips AK. Retroperitoneal, mesenteric, and omental cysts. Arch Surg. Jul 1984;119(7):838-42. [Medline].

  8. Egozi EI, Ricketts RR. Mesenteric and omental cysts in children. Am Surg. Mar 1997;63(3):287-90. [Medline].

  9. Bliss DP Jr, Coffin CM, Bower RJ, et al. Mesenteric cysts in children. Surgery. May 1994;115(5):571-7. [Medline].

  10. Chirathivat S, Shermeta D. Recurrent retroperitoneal mesenteric cyst. A case report and review. Gastrointest Radiol. Apr 15 1979;4(2):191-3. [Medline].

  11. Mollitt DL, Ballantine TV, Grosfeld JL. Mesenteric cysts in infancy and childhood. Surg Gynecol Obstet. Aug 1978;147(2):182-4. [Medline].

  12. Chung MA, Brandt ML, St-Vil D, Yazbeck S. Mesenteric cysts in children. J Pediatr Surg. Nov 1991;26(11):1306-8. [Medline].

  13. Colodny A. Mesenteric and omental cysts. In: Welch KJ, et al, eds. Pediatric Surgery. 4th ed. Chicago, Ill: Year Book Medical Publishers; 1986:921-5.

  14. Hebra A, Brown MF, McGeehin KM, Ross AJ 3rd. Mesenteric, omental, and retroperitoneal cysts in children: a clinical study of 22 cases. South Med J. Feb 1993;86(2):173-6. [Medline].

  15. Kosir MA, Sonnino RE, Gauderer MW. Pediatric abdominal lymphangiomas: a plea for early recognition. J Pediatr Surg. Nov 1991;26(11):1309-13. [Medline].

  16. Molander ML, Mortensson W, Uden R. Omental and mesenteric cysts in children. Acta Paediatr Scand. Mar 1982;71(2):227-9. [Medline].

  17. Walker AR, Putnam TC. Omental, mesenteric, and retroperitoneal cysts: a clinical study of 33 new cases. Ann Surg. Jul 1973;178(1):13-9. [Medline].

  18. Beahrs OH, Judd ES, Dockerty MB. Chylous cysts of the abdomen. Surg Clin North Am. Aug 1950;30(4):1081-96. [Medline].

  19. Gross RE. The Surgery of Infancy and Childhood. Philadelphia, Pa: WB Saunders Co; 1953:377-83.

  20. Skandalakis JE, Gray SW, Ricketts RR. The lymphatic system. In: Skandalakis JE, Gray SW, eds. Embryology for Surgeons. 2nd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1994:891-7.

  21. Feins NR, Raffensperger JG. Cystic hygroma, lymphangioma, and lymphedema. In: Raffensperger JG, ed. Swenson's Pediatric Surgery. 5th ed. Norwalk, Conn: Appleton & Lange; 1990:172-3.

  22. Ricketts RR. Mesenteric and omental cysts. In: Pediatric Surgery. 5th ed. 1998:1269-75.

  23. Maung M, Saing H. Intestinal volvulus: an experience in a developing country. J Pediatr Surg. May 1995;30(5):679-81. [Medline].

  24. Burnett WE, Rosemond GP, Bucher RM. Mesenteric cysts: Report of three cases, in one of which a calcified cyst was present. Arch Surg. 1950;60:699-706.

  25. Chou YH, Tiu CM, Lui WY, Chang T. Mesenteric and omental cysts: an ultrasonographic and clinical study of 15 patients. Gastrointest Radiol. Fall 1991;16(4):311-4. [Medline].

  26. Alqahtani A, Nguyen LT, Flageole H, Shaw K, Laberge JM. 25 years' experience with lymphangiomas in children. J Pediatr Surg. Jul 1999;34(7):1164-8. [Medline].

  27. Wong SW, Gardner V. Sudden death in children due to mesenteric defect and mesenteric cyst. Am J Forensic Med Pathol. Sep 1992;13(3):214-6. [Medline].

  28. Lockhart C, Kennedy A, Ali S, et al. Mesenteric cysts: a rare cause of abdominal pain. Ulster Med J. May 2005;74(1):60-2. [Medline].

  29. Luo CC, Huang CS, Chao HC, et al. Intra-abdominal cystic lymphangiomas in infancy and childhood. Chang Gung Med J. Jul 2004;27(7):509-14. [Medline].

  30. Nakano T, Kobayashi M, Usui T, Hanazaki K. Omental pseudocyst. Radiat Med. Aug 1 2007;25(7):364-7. [Medline].

  31. Polat C, Yilmaz S, Arikan Y, et al. Mesenteric cysts. Surg Endosc. Jan 2004;18(1):169. [Medline].

  32. Prasad KK, Jain M, Gupta RK. Omental cyst in children presenting as pseudoascites: report of two cases and review of the literature. Indian J Pathol Microbiol. Apr 2001;44(2):153-5. [Medline].

  33. Trompetas V, Varsamidakis N. Laparoscopic management of mesenteric cysts. Surg Endosc. Dec 2003;17(12):2036. [Medline].

  34. Wootton-Gorges SL, Thomas KB, Harned RK, et al. Giant cystic abdominal masses in children. Pediatr Radiol. Dec 2005;35(12):1277-88. [Medline].

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Further Reading

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Keywords

mesenteric cysts, omental cysts, cyst, abdominal cyst, intra-abdominal cyst, abdominal mass, chylous mesenteric cyst, cystic hygromas, abdominal distention, ascites, intestinal volvulus, dilated bowel, intestinal atresia, dilated stomach, pyloric atresia, gastrointestinal duplications, hydronephrosis, ovarian cyst, cystic teratoma, inguinal hernia, intestinal duplication cyst

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Contributor Information and Disclosures

Author

Amulya K Saxena, MD, Attending Pediatric Surgeon, Department of Pediatric Surgery, Medical University of Graz, Austria
Amulya K Saxena, MD is a member of the following medical societies: European Pediatric Surgeons Association, German Society of Pediatric Surgery, German Society of Surgery, and International Pediatric Endosurgery Group
Disclosure: Nothing to disclose.

Medical Editor

Kurt D Newman, MD, Vice Chairman, Department of Pediatric Surgery, Children's National Medical Center; Professor, Departments of Surgery and Pediatrics, George Washington University School of Medicine
Kurt D Newman, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Deborah F Billmire, MD, Associate Professor, Department of Surgery, Indiana University Medical Center
Deborah F Billmire, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Phi Beta Kappa, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Pediatric Oncology Group, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Harsh Grewal, MD, FACS, FAAP, Professor of Surgery and Pediatrics, Temple University School of Medicine; Chief, Section of Pediatric Surgery, Temple University Children's Medical Center
Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Children's Oncology Group, Eastern Association for the Surgery of Trauma, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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