Lymphatic Mesenteric Cyst, a Rare Cause of Surgical Abdominal Pain: Case Report and Review of the Literature

Abstract

A lymphatic mesenteric cyst (LMC) is a rare clinical entity, of unclear etiopathogenesis, which can arise in the abdominal cavity or retroperitoneum without a clear origin. We describe a case of a 74-year-old male presenting with abdominal pain that was non-specific and non-responsive to medical therapy. Laboratory tests clinical examination were inconclusive while the abdominal computed tomography (CT) scan showed a cystic lesion of the ileal mesentery. We performed an open surgical excision of the lesion with the resolution of clinical symptoms. The lesion resulted to be an LMC at the histological examination. At the five-year CT scan follow-up, we did not record any recurrences. LMCs present without specific symptoms and imaging diagnostic techniques, such as ultrasound (US) or CT scan may define its features, location, or size. The preoperative diagnosis remains difficult, which is why the complete surgical excision is the gold standard treatment, aiming to prevent malignant transformation, complications, and recurrences.

Keywords: abdominal pain; laparoscopy; mesenteric cyst; surgery.

Figure 1. Abdominal CT scan frame

Showing a cystic hypodense lesion with hyperdense content located between the mesenteric vessels in the left lower abdominal quadrant, which determines a dislocation of the intestinal loops and vessels along with hyperdensity of the surrounding fatty tissue. CT: computed tomography

Figure 2. Hematoxylin-eosin, wholemount

A lymphatic mesenteric cyst with serous content and a cystic lumen lined with endothelial cells of lymphatic subtype, flattened in a mono-stratified layer