Mohamad F. Ayas, MD1, Saif Affas, MD1, Gilles J. Hoilat, MBBS2, Mohammed Barawi, MD1; 1Ascension St. John Hospital, Detroit, MI; 2SUNY Upstate Medical University, Syracuse, NY
Introduction: Mesenteric cysts are rare benign intra-abdominal tumors with an incidence of approximately 1 case per 100,000-250,000hospital admissions. Thiswas first described in 1507 by Italian anatomist Benevenni while performing an autopsy. Unfortunately, exact etiology is still unknown, but the most accepted theory is thought to be a benign proliferation of ectopic lymphatics in the mesentery. This benign lesion has a lowincidence rate, as they are considered the rarest variety between abdominal cysts.
Methods: This is a 35-year-old African American female with a past medical history of chronic cholelithiasis presented to the hospital with complaints of worsening right upper quadrant(RUQ) abdominal pain and nausea for a few months. Patient had no weight loss,or loss of appetite,and no history of alcoholism or pancreatitis. Patient was vitally stable. Exam showed mild RUQ tenderness, and a negative murphy’s sign. Labs revealed mild transaminitis with a normal serum lipase. Computerized tomography (CT)was performed, showing a large cystic mass in the RUQ measuring 10.3 x 9.8 x 11.3 cm exerting mass effect on the pancreas and gallbladder with mild intrahepatic biliary ductal dilatation.Endoscopic ultrasonography(EUS) was done for possible drainage via axios stent, but aseptatedcystic structure was seen.Given no history of pancreatitisand thecomplexity of the cyst,fine needle aspiration was performed instead, showing a bile-like fluid aspiratesuggesting a possible biloma. Fluid analysis was negative for bilirubin, carcinoembryonic antigen and lipase.Patient thenunderwent an exploratory laparotomy which revealed a massadherent to the gallbladder, but intra-operative cholangiogram was negative for any communication.Cholecystectomy and cyst removal were performed, and pathology was consistent with a mesenteric cyst. Discussion: Mesenteric cysts aredefined as any cyst in the mesentery of the gastrointestinal tract that may extend into the retroperitoneum.They can present at any age but are most seen in the second decade of life. Most areidentifiedaspainless,mobile, periumbilicalmasses, and treatment is usually surgical resection without drainage,if symptomatic. We present a case of an abnormally locatedmesenteric cyst, mimicking biliary/pancreatic pathology, and although low on the differential, one must look at the patient’s history and not assume all abdominal cysts are common and drainable, as not all abdominal cysts are created equally.
Computerized tomography showing a 10.3 x 9.8 x 11.3 cm cystic structure
Endoscopic Ultrasonography showing a septated cystic structure
Disclosures: Mohamad Ayas indicated no relevant financial relationships. Saif Affas indicated no relevant financial relationships. Gilles Hoilat indicated no relevant financial relationships. Mohammed Barawi indicated no relevant financial relationships.