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, 33]}

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:

Dilated bowel (eg, intestinal atresia)
Dilated stomach (eg, pyloric atresia)
Gastrointestinal duplication
Hydronephrosis
Ovarian cyst
Cystic teratoma

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.^[34]

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.^[35] A congenital giant omental hemorrhagic cyst presenting as acute hemorrhagic anemia in an infant was described in a case report by Kokhanovsky et al.^[36]

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]

Workup

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Media Gallery

Large mesenteric cyst arising from the small-bowel mesentery.
Huge omental cyst within the greater omentum.
Small omental cyst arising on a pedicle from the greater omentum in the region of the transverse colon.
Multiple mesenteric cysts, some filled with chyle, arising from the jejunal mesentery.
Huge mesenteric cyst arising from the transverse colon mesentery. Resection was required to remove this cyst.
Multiple jejunal mesenteric cysts surrounding a loop of jejunum. Intestinal resection was required to remove these cysts.
Ultrasound image demonstrating a thin-walled mesenteric cyst with an internal septum.

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Sections Mesenteric and Omental Cysts in Children
Overview
Presentation
Workup
Treatment
Media Gallery
References

Mesenteric and Omental Cysts in Children Clinical Presentation

History and Physical Examination

Complications

References

Tables

Contributor Information and Disclosures

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