Surgical management for mesenteric cysts in pediatric patients: a single center experience

Background: Mesenteric cysts are exceptional abdominal lesions of childhood. Presentation may vary with broad spectrum of symptoms from asymptomatic mass and nonspecific complaints to an acute abdomen. Objectives of this study were to present a series of patients with mesenteric cysts and to analyze our experience with emphasis on the presentation, management, and outcome.Methods: This observational study included thirteen children were diagnosed and treated for mesenteric cysts. All cases subjected to clinical evaluation, laboratory investigations and radiological studies. The diagnosis was confirmed on laparotomy. Ethics committee approval was obtained. The main data which extracted and analyzed included demographic data, operative finding, postoperative complications and duration of hospital stay. Data were analyzed using SPSS for Windows software and P value of ≤ 0.05 was considered significant.Results: There were 13 patients with mesenteric cyst, 5 girls and 8 boys. The ages ranged from neonate to 8 years. Abdominal mass and pain was the main presenting symptoms. Prenatal diagnosis established in two cases. Laparotomy performed in all cases. Small bowel mesentery is the commonest site. Two patients required urgent surgery. Surgical procedures included cyst excision with or without intestinal resection. Chylolymphatic cyst was documented in 4 cases. Post-operative complications reported in 2 cases.Conclusions: Mesenteric cysts are unusual in children with variable clinical presentation. Complete excision was feasible in nearly all cases, bringing a favorable outcome. The possibility of this disease entity should be considered as the cause of acute abdomen.

Download Full-text

Mesothelial Cyst in a Young Female: Case report and literature review

International Journal of Case Reports ◽

10.28933/ijcr-2021-02-2005 ◽

2021 ◽

pp. 203

Author(s):

◽

Keyword(s):

Abdominal Mass ◽

Correct Diagnosis ◽

Young Female ◽

Cystic Mass ◽

Mesenteric Cyst ◽

Benign Tumors ◽

Presenting Symptoms ◽

Abdominal Symptoms ◽

Mesothelial Cyst ◽

Mesenteric Cysts

Mesenteric cysts are rare intra-abdominal benign tumors (1 in 100,000 cases in adults) with various clinical presentations. [1,2] They commonly originate from the small bowel mesentery, although a proportion has been found to originate from the mesocolon, and retroperitoneum. [1,3] The formation of mesenteric cysts depends on the histologic origin, where they could be classified into cysts of lymphatic origin, cysts of mesothelial origin, cysts of enteric origin, cysts of urogenital origin, dermoid cysts and pseudocysts. [4,5] Diagnosis is extremely difficult since. The Mesenteric cyst is usually asymptomatic, but if symptomatic, abdominal pain (82%), nausea and vomiting (45%), constipation (27%) are the most common presenting symptoms. [2,3] The clinical finding of abdominal mass is encountered in more than 61% of the patients. [2,3]. As this condition is very rare and its symptomatology can resemble any other abdominal diseases, diagnosis is extremely difficult and incorrect preoperative diagnosis is often made. Hence, performing physical examination and conducting radiological investigations such as ultrasonography (USG) and computed tomography (CT) are important in making a correct diagnosis. [2,3] As well as cases of mesothelial cysts, they are typically asymptomatic but occasionally, their symptoms are vague and non-specific. [6,7] As mentioned above, imaging modalities such as USG, CT and magnetic resonance imaging (MRI) are great in identifying the character, size, location, surrounding tissues and the wall and content of the cysts. [7] Surgery is the treatment of choice, as a complete resection with negative borders is curative and often prevents recurrence. [3] We report a case of a young female patient who presented with a vague abdominal symptoms and a large cystic mass in lower abdomen. After proper evaluation, surgical exploration revealed a large simple mesothelial cyst.

Download Full-text

Mesenteric cyst

Archive of oncology ◽

10.2298/aoo0704091m ◽

2007 ◽

Vol 15 (3-4) ◽

pp. 91-93 ◽

Cited By ~ 9

Author(s):

Dragoslav Miljkovic ◽

Dragojlo Gmijovic ◽

Milan Radojkovic ◽

Jasmina Gligorijevic ◽

Zoran Radovanovic

Keyword(s):

Clinical Presentation ◽

Histopathological Examination ◽

Abdominal Mass ◽

Mesenteric Cyst ◽

Epithelial Lining ◽

Left Hypochondrium ◽

Mesenteric Cysts ◽

Traumatic Origin ◽

Fibrous Cyst ◽

Low Incidence

Mesenteric cysts are rare abdominal findings. Due to absent or unspecific clinical presentation, very low incidence, and lack of adequate classification these cysts may sometimes represent a diagnostic and therapeutic challenge. We report a case of 37-year-old man with vague palpatory tenderness in left hypochondrium and paraumbilically and with palpable large intra-abdominal mass in whom mesenteric cyst was diagnosed using US and CT imaging. He was operated and cyst was extirpated in toto. Histopathological examination revealed a thick fibrous cyst wall with the signs of chronic inflammation and without inner epithelial lining, which suggested its traumatic origin. Considering the possibility of malignancy mesenteric cysts should be radically resected (with resection of adjacent organs if necessary) due to their strong relapsing potential and a tendency for sudden, progressive local enlargement if not removed in toto.

Download Full-text

Complete Surgical Enucleation of a Giant Chylous Mesenteric Cyst

Case Reports in Surgery ◽

10.1155/2020/4279345 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Maria Isaia ◽

Maria Erodotou ◽

Georgios Nakos ◽

Nikolaos Nikolaou

Keyword(s):

Bowel Resection ◽

Histopathological Examination ◽

Incidental Finding ◽

Abdominal Mass ◽

Mesenteric Cyst ◽

Abdominal Tumors ◽

Mesenteric Cysts ◽

Laparoscopic Enucleation ◽

Chylous Mesenteric Cyst ◽

Palpable Abdominal Mass

Mesenteric cysts are rare benign abdominal tumors, and they can appear anywhere in the mesentery of the gastrointestinal tract, from the duodenum to the rectum. They are generally asymptomatic and may present as an incidental finding. The diagnosis is confirmed by the laparotomy findings and the results of the histopathological examination. Complete surgical (open or laparoscopic) enucleation of the cyst is the treatment of choice. We present a case of a female patient who presented with abdominal pain and a giant palpable abdominal mass. The patient underwent a surgical exploration which showed a giant mesenteric cyst. A complete surgical enucleation of the cyst was successfully performed without the need of bowel resection. The histopathological examination of the cyst was compatible with the diagnosis of chylous mesenteric cyst.

Download Full-text

Pathological Discrepancy: Simple Mesenteric Cyst vs. Mesenteric Lymphangioma

Case Reports in Surgery ◽

10.1155/2021/8848462 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Vygintas Aliukonis ◽

Marius Lasinskas ◽

Algirdas Pilvelis ◽

Audrius Gradauskas

Keyword(s):

Histological Finding ◽

Cystic Lymphangioma ◽

Mesenteric Cyst ◽

Histological Structure ◽

Complete Excision ◽

Case Presentation ◽

Mesenteric Lymphangioma ◽

Cystic Lymphangiomas ◽

Mesothelial Cyst ◽

Mesenteric Cysts

Introduction. Both mesenteric cysts and cystic lymphangiomas are scarce and clinically and radiologically almost identical derivatives, but their histological structure is fundamentally different. Case Presentation. A 52-year-old woman was consulted by a surgeon for a derivative felt in her abdomen. The patient said she felt a growing derivative in the abdomen about a month ago. After consulting and testing, a sigmoid colon mesenteric cyst ( 13 cm × 11 cm × 10 cm ) was found. Complete excision of the cyst within healthy tissues was performed through laparotomy. The surgery had no complications. The initial pathological answer was a simple mesothelial cyst (a rare histological finding). However, immunohistochemical tests were performed that showed that diagnosis was mesenteric cystic lymphangioma (ML). Cystic lymphangiomas that have a link to the mesentery have been described less than 200 times. Conclusions. Final differential diagnosis between different cystic derivatives is possible only based on histopathological examinations. Mesenteric lymphangioma is most common at a very young age, but in rare cases, it also occurs in adults. All clinicians should increase their awareness of the disease.

Download Full-text

POS0548 OPTIMAL ASSESSMENT OF THE RHEUMATOID ARTHRITIS ANKLE AND HINDFOOT: A COMPARATIVE STUDY BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2720 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 508.2-509

Author(s):

K. Maatallah ◽

H. Boussaa ◽

H. Riahi ◽

H. Ferjani ◽

M. Habechi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Examination ◽

Demographic Data ◽

Power Doppler ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Therapeutic Decisions ◽

The Mean ◽

Foot Disease

Background:Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.Objectives:The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).Conclusion:Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.Disclosure of Interests:None declared

Download Full-text

Association of interleukin-17A rs2275913 polymorphism with rheumatoid arthritis susceptibility in Sudanese population

SAGE Open Medicine ◽

10.1177/20503121211020207 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110202

Author(s):

Rgda Mohamed Osman ◽

Mounkaila Noma ◽

Abdallah Elssir Ahmed ◽

Hanadi Abdelbagi ◽

Rihab Ali Omer ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Confidence Interval ◽

Statistical Tests ◽

Demographic Data ◽

Control Group ◽

P Value ◽

Case Group ◽

Molecular Technique ◽

Interleukin 17A ◽

Significant Difference

Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients. Methods: A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05. Results: The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002). Conclusion: This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis

Download Full-text

Serum neurofilament light chain as a severity marker for spinocerebellar ataxia

Scientific Reports ◽

10.1038/s41598-021-92855-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hye-Rim Shin ◽

Jangsup Moon ◽

Woo-Jin Lee ◽

Han Sang Lee ◽

Eun Young Kim ◽

...

Keyword(s):

Spinocerebellar Ataxia ◽

Disease Duration ◽

Trinucleotide Repeat ◽

Neuronal Damage ◽

Demographic Data ◽

Brain Magnetic Resonance Imaging ◽

Clinical Severity ◽

P Value ◽

Repeat Number ◽

Neurofilament Light

AbstractSince the serum neurofilament light (NfL) chain is known as a promising biomarker in neurodegenerative diseases, we aimed to evaluate serum NfL as a biomarker indicating neuronal damage in autosomal-dominant (AD) spinocerebellar ataxia (SCA). We reviewed patients diagnosed with AD SCA in the outpatient clinic of Seoul National University Hospital’s (SNUH) Department of Neurology between May and August of 2019. We reviewed the demographic data, clinical characteristics, Scale for the Assessment and Rating of Ataxia (SARA) score, and brain magnetic resonance imaging (MRI) scans. The serum NfL was measured by electrochemiluminescence (ECL) immunoassay. Forty-nine patients with AD SCA were reviewed and their serum NfL level was determined. The median serum NfL level (109.5 pg/mL) was higher than control (41.1 pg/mL) (p-value < 0.001). Among the AD SCA patients, there was a positive correlation between the serum NfL level and the trinucleotide repeat number (r = 0.47, p-value = 0.001), disease duration (r = 0.35, p-value = 0.019), disease duration/age × trinucleotide repeat number (r = 0.330, p-value = 0.021), and SARA score (n = 33; r = 0.37, p-value = 0.033). This study shows that serum NfL is elevated in AD SCA patients and correlates with clinical severity.

Download Full-text

The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis

The American Surgeon ◽

10.1177/0003134820973719 ◽

2020 ◽

pp. 000313482097371

Author(s):

Shekhar Gogna ◽

David Samson ◽

James Choi ◽

Jorge Con ◽

Kartik Prabhakaran ◽

...

Keyword(s):

Propensity Score ◽

Abdominal Surgery ◽

Acute Abdomen ◽

Anastomotic Dehiscence ◽

The Elderly ◽

Major Surgery ◽

P Value ◽

Gastrointestinal Complications ◽

Group I

Background About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. Methods We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65 years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2 days of hospital admission. Results Of 3 246 721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) ( P-value <.01, respectively). Discussion Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

Download Full-text

A Rare Cause of Mechanical Intestinal Obstruction: A Neoplastic Intra-Abdominal Testis

International Surgery ◽

10.9738/intsurg-d-15-00141.1 ◽

2016 ◽

Vol 101 (3-4) ◽

pp. 167-170

Author(s):

Fatih Ciftci ◽

Suat Benek ◽

Cem Kezer

Keyword(s):

Intestinal Obstruction ◽

Acute Abdomen ◽

Undescended Testis ◽

Abdominal Mass ◽

Relevant Literature ◽

Large Diameter ◽

Exploratory Laparotomy ◽

Clinical Findings ◽

Surgical Units ◽

Mechanical Intestinal Obstruction

The acute abdomen has many etiologies frequently encountered in emergency surgical units. Approximately 20% of surgical admissions for acute abdominal conditions are for intestinal obstruction. Clinicians often overlook rarer causes. A 43-year-old man presented to the emergency ward with the clinical findings of ileus. Computed tomography revealed a heterogeneous necrotic 168 × 100-mm mass between the sigmoid colon and urinary bladder. Physical examination revealed a palpable intra-abdominal mass that was removed via exploratory laparotomy. On histopathologic examination, the mass was identified as a seminoma. The literature contains few reports of seminoma as a cause of acute abdomen and ileus, mostly seen between the ages of 30 and 40 years. We report a patient with seminoma arising in an undescended testis that presented as a palpable painful lower abdominal mass and mechanical intestinal obstruction, despite the large diameter of the mass, as well as review relevant literature.

Download Full-text