Mesenteric and Omental Cysts in Children Clinical Presentation

Updated: Aug 15, 2018
  • Author: Amulya K Saxena, MD, PhD, DSc, FRCS(Glasg); Chief Editor: Harsh Grewal, MD, FACS, FAAP  more...
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Presentation

History and Physical Examination

A mesenteric or omental cyst may be discovered as an incidental finding during laparotomy for another condition, or it may manifest as an acute life-threatening intra-abdominal catastrophe. [6]

Children generally present with abdominal distention and few associated symptoms other than vague abdominal pain with or without a palpable mass. [5, 29, 30] The mass may be huge, simulating ascites. [31, 32] The most common mode of acute presentation in children is that of a small-bowel obstruction, which may be associated with intestinal volvulus or infarction. [9, 6, 25]

Approximately 10% of patients with mesenteric and omental cysts present with an acute abdominal emergency. [6] These masses can be detected with antenatal ultrasonography (US) and appear as a sonolucent mass. The antenatal differential diagnosis includes the following:

In a series of 82 children who underwent surgery for various causes of intestinal volvulus, mesenteric cysts were the underlying etiology in 3.65% of cases. [33]

A very unusual presentation of a mesenteric cyst is that of an irreducible inguinal hernia. [1] The differential diagnosis includes the following [6] :

  • Intestinal duplication cyst
  • Ovarian, choledochal, pancreatic, splenic, or renal cysts
  • Hydronephrosis
  • Cystic teratoma
  • Hydatid cyst
  • Ascites

An extragastrointestinal stromal tumor presenting as an omental cyst was described in a case report by Monabati et al. [34]  A congenital giant omental hemorrhagic cyst presenting as acute hemorrhagic anemia in an infant was described in a case report by Kokhanovsky et al. [35]

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Complications

Various complications have been associated with mesenteric and omental cysts, including the following [6] :

  • Intestinal obstruction (most common)
  • Volvulus
  • Hemorrhage into the cyst
  • Infection
  • Rupture
  • Cystic torsion
  • Obstruction of the urinary and biliary tract

Malignant transformation of mesenteric cysts has occurred in adults, [18] but malignant mesenteric and omental cysts have not been reported in children. [6]

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