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      Giant sixteen kilogram lymphangioma mesenteric cyst: An unusual presentation of a rare benign tumour

      case-report

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          Highlights

          • Mesenteric cysts may present as giant abdominal masses.

          • It is the heaviest (16 kg) mesenteric cyst reported in the literature to date.

          • In low incomes countries, the interval between the onset of symptoms and consultation is often significant, leading to unusual presentations.

          Abstract

          Background

          Mesenteric cysts are rare abdominal benign tumours with an incidence of 1:100.000–250.000 surgical admissions located in the mesentery. Theirs presentations may range from incidental asymptomatic discovery during imaging to non-specific abdominal symptoms.

          Case presentation

          We present the case of a 46 year old female who presented with 9 months history of progressive abdominal distension. CT scan showed a giant abdominal mass. After the necessary preoperative work up, a midline incision laparotomy was performed. Intraoperative findings were a mesenteric cyst originates from the transverse mesocolon. The cyst weighed 16 kg and histopathology analyses confirmed a lymphangioma mesenteric cyst.

          Discussion

          In low incomes countries like our own, the interval between the onset of symptoms and consultation is often significant, leading to unusual and sometimes spectacular presentations at the time of diagnosis. To our knowledge, it is the heaviest mesenteric cyst reported in the literature to date.

          Conclusion

          Mesenteric cysts may present as giant abdominal masses. The publication of this atypical case is a plea for us for the establishment of universal health coverage in our country in particular and in Africa in general.

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          Most cited references13

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          Mesenteric and retroperitoneal cysts.

          Mesenteric and retroperitoneal cysts are rare intra-abdominal tumors. Ten new patients are presented as well as 152 other cases reported in the English literature. These 162 cases were then analyzed for significant trends. Patients under 10 years of age were significantly different from the older group with respect to a shorter duration of symptoms, a higher number of patients requiring an emergency operation, a lower number of recurrences and the location of the cyst. Patients with retroperitoneal cysts were more likely to have incomplete excision of the cyst and therefore had a higher incidence of recurrence. They also required marsupialization more often. Retroperitoneal cysts should be considered a different entity from mesenteric cysts even though they present clinically in a similar fashion. The outcome of surgical treatment is less satisfactory in patients with retroperitoneal cysts.
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            Mesenteric cyst.

            Mesenteric cyst is one of the rarest abdominal tumours, with approximately 820 cases reported since 1507. The incidence varies from 1 per 100,000 to 250,000 admissions. The lack of characteristic clinical features and radiological signs may present great diagnostic difficulties. The cyst may present in one of three ways: (i) non-specific abdominal features; (ii) an incidental finding; or (iii) an acute abdomen. Abdominal pain is the major presenting symptom. Abdominal mass is found in more than 50% of cases and 40% of cases are discovered incidentally. More than one aetiological mechanism is probably involved in the development of mesenteric cysts. Mesenteric cysts have been reported from the duodenum to the rectal mesentery but are most commonly located in the ileal mesentery. Malignant cysts occur in less than 3% of cases. Enucleation of the cyst is the treatment of choice. Knowledge of these tumours is important due to the various complications associated with suboptimal surgical management. Two cases of mesenteric cysts are presented including a recurrent mesenteric cyst in a post-partum woman demonstrating the inferior technique of internal marsupialization. The association of mesenteric cyst with pregnancy is discussed.
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              Mesenteric and omental cysts in children.

              Mesenteric and omental cysts are rare intra-abdominal lesions. The rarity of these lesions, with an incidence of only about 1 in 140,000 hospital admissions, and the absence of characteristic clinical findings makes diagnosis difficult. Fourteen patients were treated for either mesenteric and/or omental cysts between 1965 and 1994 at Egleston Children's Hospital at Emory University. Of the 14 patients, 6 were female, 8 male; 3 were non-Caucasian, and 11 were Caucasian. They ranged in age from in-utero to 12 years old, with the most common presenting symptoms being abdominal distention (71%), pain (50%), vomiting (50%), and pain and distention (43%). Ultrasonography was the diagnostic method of choice. Other diagnostic modalities included intravenous pyelogram, barium enema, upper gastrointestinal series, CT scan, and MRI in selected patients. A single mesenteric cyst (79%) was most common, with only one patient (7%) having multiple mesenteric cysts as well as an omental cyst. The remaining two patients (14%) had single omental cysts. On gross examination, most (64%) were single, multilocular cysts. On pathological examination, the cysts ranged in size from 3.5 x 1 x 0.2 cm to 30 x 40 x 10 cm, with a mean of 14.9 x 11.5 x 4.7 cm. Six of the 14 contained fluid consistent with hemorrhage into the cysts. The most common treatment was simple excision (71%) followed by excision with partial bowel resection (29%). None received drainage alone as a treatment. There were no major postoperative complications and no reported recurrences of the cysts.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                14 May 2019
                2019
                14 May 2019
                : 59
                : 94-96
                Affiliations
                [a ]Department of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
                [b ]Surgical Unit, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
                Author notes
                [* ]Corresponding author. guyaristidebang@ 123456yahoo.fr
                Article
                S2210-2612(19)30265-2
                10.1016/j.ijscr.2019.05.019
                6531822
                31125789
                c514a760-cc57-4cdd-9a0a-0a6dff78f739
                © 2019 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 9 April 2019
                : 5 May 2019
                Categories
                Article

                mesenteric cyst,transverse mesocolon,giant abdominal mass,low incomes country,case report

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