eMedicine Specialties > Pediatrics: Surgery > General Surgery

Mesenteric and Omental Cysts: Treatment

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

Treatment

Medical Therapy

No medical therapy is available.

Surgical Therapy

The goal of surgical therapy is complete excision of the mass. Omental cysts can be removed without endangering the adjacent bowel.9,13,14 The preferred treatment of mesenteric cysts is enucleation,5,7,14,21 although intestinal resection is frequently required to ensure that the remaining bowel is viable. Bowel resection may be required in 50-60% of children with mesenteric cysts, whereas resection is necessary in about one third of adults.5,9,11,13,15 Any resulting mesenteric defect must be closed to prevent an internal hernia.

If enucleation or resection is not possible because of the size of the cyst or because of its location deep within the root of the mesentery, the third option is partial excision with marsupialization of the remaining cyst into the abdominal cavity.22 Approximately 10% of patients require this form of therapy.5 If marsupialization is performed, the cyst lining should be sclerosed with 10% glucose solution,10 electrocautery, or tincture of iodine to minimize recurrence. Partial excision alone with or without drainage is not indicated because of the high recurrence rate associated with these procedures.5

Preoperative Details

The patient should undergo standard preoperative preparation for a major laparotomy. This includes inserting a nasogastric tube, initiating intravenous fluid therapy, and beginning prophylactic antibiotics preoperatively in the event that a bowel resection is required. If time allows, the patient should undergo mechanical bowel preparation for the same reason.

Intraoperative Details

Mesenteric cysts can be shelled out from between the leaves of the mesentery using fine electrocautery, taking care not to damage the blood vessels to the adjacent intestine. If this is not feasible, a standard bowel resection with a primary end-to-end anastomosis is performed. Intestinal diversion is not necessary unless gross peritonitis from a long-standing bowel perforation is present.

Omental cysts are excised by removing the involved portion of the mesentery up to the transverse colon if necessary. In the vast majority of cases, removing the adjacent colon or stomach is not necessary.13,14

Postoperative Details

The patient is maintained nothing by mouth (NPO) with intravenous fluids and nasogastric suction until bowel function returns. Prophylactic antibiotics can be discontinued after 1-2 postoperative doses. If the patient is not able to eat by the third postoperative day, parenteral nutrition should be provided.

Follow-up

Routine postoperative follow-up care 2-3 weeks after discharge from the hospital is indicated. The child's family should be warned about the potential for intestinal obstruction from adhesions. If the patient was treated with marsupialization, closer follow-up for possible recurrence should be instituted. Otherwise, no long-term follow-up for surgical problems is necessary.

Complications

Complications from surgery, either early or late, are uncommon.8 Complications associated with mesenteric and omental cysts are discussed above.

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

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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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