Ideal treatment strategy for chylous mesenteric cyst: a case report

Abstract

Background: A mesenteric chylous cyst is defined as a cyst occurring in the mesentery of the gastrointestinal tract anywhere from the duodenum to the rectum and is diagnosed most often during the fifth decade of life.

Case presentation: In our case report, we describe a case of 38-year-old Greek woman who presented at our Emergency Department complaining of abdominal pain without any other symptoms. Her medical and family histories were clear and she had never had any abdominal interventions. During an imaging examination with ultrasound of her abdomen, an anechoic lesion in her upper left abdomen was revealed. In a further investigation with computed tomography, a well-defined hypodense cystic 7.08 × 6.05 cm mass with mild enhancement was noted. The mass was excised by open laparotomy within healthy borders and the specimen was sent for pathological examination. The histopathological findings were found to be most consistent with a simple lymphatic (chylous) cyst of the mesentery. A review of the literature considering this rare entity was also performed to evaluate our treatment strategy and the result was analyzed.

Conclusions: Chylous cysts represent a diagnostic challenge and they should be considered when a physician encounters an intraabdominal mass. Physical examination and imaging do not always provide a diagnosis and surgical management should be advised due to the potential complications that may develop.

Keywords: Chylous mesenteric cyst; Computed tomography; Laparotomy; Lymphatic cyst; Ultrasound.

Fig. 1

PRISMA Chart with the exclusion articles

Fig. 2

Computed tomography showed a well-defined hypodense cystic 7.08 × 6.05 cm chylous cyst with mild enhancement

Fig. 3

Intraoperative image of mesentery cyst with well-defined wall

Fig. 4

Final specimen

Fig. 5

Cyst wall with lymphoid aggregates, hematoxylin and eosin × 100 (a) and CD31+ vessels, immunohistochemical × 200 (b)

Fig. 6

Foreign-body giant cell in the lumen, hematoxylin and eosin × 200 (a) as well as CD68+, foamy macrophages, immunohistochemical × 40 (b)