Approach Considerations

No specific laboratory studies aid in the diagnosis of mesenteric and omental cysts. Aside from imaging studies (see below), no tests or diagnostic procedures are necessary.

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, 5]} Fine calcifications can sometimes be observed within the cyst wall.^{[6, 39, 40]}

Ultrasonography

The imaging modality of choice is abdominal ultrasonography (US).^{[10, 26, 27, 40]}US reveals fluid-filled cystic structures, commonly with thin internal septa and sometimes with internal echoes from debris, hemorrhage, or infection.^{[11, 27, 40, 41]}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 US.

Ultrasound image demonstrating a thin-walled mesenteric cyst with an internal septum.

View Media Gallery

Other modalities

Abdominal computed tomography (CT) adds minimal additional information, though it can reveal that the cyst is not arising from another organ such as the kidney, pancreas, or ovary.^[9] Radionuclide scanning of the biliary tract excludes choledochal cysts from diagnostic consideration.^[6]Contrast CT aided by angiography may be useful in cases of large omental cysts.^[42]

Histologic Findings

Cystic lymphangiomas are sometimes differentiated from mesenteric and omental cysts.^{[15, 11, 26]}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.^[15]

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.^{[15, 26, 43]}In a series of 191 patients with lymphangioma, 4.7% of patients presented with lymphangioma in the mesentery.^[44]

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.^[6]

Treatment & Management

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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.