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Frontiers in Pediatrics 2022Preoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three...
BACKGROUND
Preoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three major preoperative complications (hemorrhage of the cyst, infection of the cyst and intestinal volvulus) in ML patients, and explore their influence on the outcomes.
METHODS
This retrospective cohort study enrolled ML patients undergoing surgery at Beijing Children's Hospital between June 2016 and June 2022 and classified them according to different preoperative complications, preoperative hemorrhage or infection, and preoperative intestinal volvulus. The groups were examined and compared according to sex, age at admission, presenting symptoms, laboratory examinations, imaging examinations, preoperative treatments, cyst characteristics, surgical details, perioperative clinical data, and follow-up. Logistic regression analysis was performed to identify the independent risk factors for preoperative hemorrhage or infection, and preoperative intestinal volvulus.
RESULTS
Of the 104 enrolled ML patients, 27 (26.0%) had preoperative hemorrhage or infection, and 22 (21.2%) had preoperative intestinal volvulus. Univariate analysis showed that patients with preoperative hemorrhage or infection had a higher rate of ML in the mesocolon (44.4 vs. 23.4%, < 0.038) and larger cysts (10 vs. 8 cm, = 0.042) than patients without preoperative hemorrhage or infection. Multivariable logistic regression analysis found that the location (OR, 3.1; 95% CI, 1.1-8.6; = 0.026) and size of the cyst (≥7.5 cm) (OR, 6.2; 95% CI, 1.6-23.4; = 0.007) were independent risk factors for preoperative hemorrhage or infection. Preoperative intestinal volvulus was only found in ML at the intestinal mesentery. Further analysis showed that ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus (OR, 3.3; 95% CI, 1.1-10.0; = 0.027). Patients with preoperative hemorrhage or infection spent more on hospitalization costs than patients without preoperative hemorrhage or infection (3,000 vs. 2,674 dollars, = 0.038).
CONCLUSIONS
ML patients should be treated as soon as possible after diagnosis. The location and size of the cyst were independent risk factors for preoperative hemorrhage or infection. ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus.
PubMed: 36245723
DOI: 10.3389/fped.2022.1033897 -
Case Reports in Surgery 2022Paratubal cysts are adnexal masses located in the broad ligament; whenever the size of the cyst is >20 cm, it is considered a giant cyst and can present with...
Paratubal cysts are adnexal masses located in the broad ligament; whenever the size of the cyst is >20 cm, it is considered a giant cyst and can present with complications including ovarian torsion and perforation. Diagnosis can be made clinically with the help of radiological investigations, although the gold standard diagnostic tool is diagnostic laparoscopy. Managing this condition relies mainly on surgical intervention (open or laparoscopic). Giant paratubal cysts carry challenges in their surgical excision as they carry a higher risk of spillage. We present a case of giant paratubal cyst in a 26-year-old Bahraini female who presented with abdominal distension and pain for 3 years.
PubMed: 36245686
DOI: 10.1155/2022/4909614 -
Khirurgiia 2022A rare case of surgical treatment of mesenteric cyst of the small bowel is described. The diagnosis was confirmed by irrigography and contrast-enhanced computed...
A rare case of surgical treatment of mesenteric cyst of the small bowel is described. The diagnosis was confirmed by irrigography and contrast-enhanced computed tomography of the abdomen. The patient underwent small bowel and mesentery resection with subsequent entero-enteroanastomosis. Postoperative period was uneventful. This case confirms advisability of total en-bloc excision of the cyst via resection of intact mesentery and small bowel segment. Literature data indicate that the only treatment method for mesenteric cysts is surgery.
Topics: Abdominal Cavity; Humans; Intestine, Small; Mesenteric Cyst; Mesentery; Tomography, X-Ray Computed
PubMed: 36223154
DOI: 10.17116/hirurgia202210175 -
Case Reports in Oncology 2022Retroperitoneal masses are a rare condition that may be discovered incidentally in routine abdominal imaging. These lesions are commonly asymptomatic but may be...
Retroperitoneal masses are a rare condition that may be discovered incidentally in routine abdominal imaging. These lesions are commonly asymptomatic but may be associated with intestinal obstruction and rarely presented with acute abdomen. They may originate from the retroperitoneal organs, including the genitourinary or gastrointestinal tract, or originate primarily from retroperitoneal space, such as retroperitoneal fat, muscle, nervous system, and lymphatic system. The malignant masses are more common than benign masses, and sarcoma is the most malignant tumor in this space. We present a case with the hilar lesion of the left kidney that was managed with laparoscopic resection. The laparoscopy revealed that the mass completely enclosed the left renal hilum, but the mass was excised without any complication. The final pathologic report revealed a benign mesenteric cyst. Although most of the retroperitoneal mass had a malignant etiology, in cystic lesions in the renal hilar area, the benign mesenteric cyst may keep in mind the differential diagnosis of a mass in this anatomic region.
PubMed: 36157686
DOI: 10.1159/000525841 -
Radiology Case Reports Nov 2022Chronic midgut malrotation is a rare condition found in the adult age that predisposes to severe complications. It derives from an incomplete rotation of the mesentery...
Chronic midgut malrotation is a rare condition found in the adult age that predisposes to severe complications. It derives from an incomplete rotation of the mesentery around the superior mesenteric artery during embryogenic development. This results in intestinal loops displacement and mesenteric malfixation. Nevertheless, other congenital abnormalities can be also associated, such as mesenteric cysts and biliopancreatic malformations. Imaging modalities employed in the evaluation of chronic midgut malrotation include contrast radiography, which permits to visualize the localization of the intestinal loops, and ultrasound, that can detect a twist of superior mesenteric vessels. Computed tomography is however considered the modality of choice, owing to its wide field of view and the rapid scan times. The role of magnetic resonance imaging in this field has been barely explored. In particular, magnetic resonance enterography has a consolidated role in the assessment of intestinal loops and allows detecting extra-intestinal findings as well. Moreover, the lack of radiation exposure makes this technique suitable for nonemergency cases, especially in young patients. This is the first description of simultaneous chronic midgut malrotation, mesenteric cyst and pancreas divisum discovered in a Crohn's disease patient. The performance of magnetic resonance enterography allowed to properly interpret this multifaceted clinical picture.
PubMed: 36124320
DOI: 10.1016/j.radcr.2022.08.045 -
International Journal of Surgery Case... Oct 2022Hydatidosis, a common zoonotic disease, especially in countries which are poorly developed, is not only capable of affecting a huge number of humans but also animals.
INTRODUCTION AND IMPORTANCE
Hydatidosis, a common zoonotic disease, especially in countries which are poorly developed, is not only capable of affecting a huge number of humans but also animals.
CASE PRESENTATION
A 40-year-old female presented to our hospital complaining of the left flank and left upper quadrant pain increasing with exertion for three years. Physical findings revealed a firm lump in the left upper quadrant area extending to the left flank about (15cmx14.5 cm) in size. Abdominal CT scan reported a well defined low attenuating fluid density consistent with thick walled cystic lesion in the left upper quadrant, which is not separable from the lower pole of left kidney as well as pancreatic tail, showing significant mass effect over the left renal pelvis resulting in moderate dilatation of left pelvi-calyceal system superiorly. Our case was managed with the removal of laminated membrane of the cyst and followed by Mebendazole therapy.
CLINICAL DISCUSSION
The disease is commonly caused by Echinococcosis granulosus, the parasite mostly takes place in the liver (70 %) and in the lungs (25 %). In 13 % of cases the primary hepatic cyst raptures causing the formation of intraperitoneal cyst, however the primary intraperitoneal hydatid cyst (2 %) and the primary mesenteric hydatid cysts are very rare. Considering the possibility of hydatid cyst especially in the endemic regions is highly recommended because in these regions there are many diversities in the presentation. As surgical excision with subsequent Mebendazole therapy for four months is the proper treatment for these cases.
CONCLUSION
Primary hydatid cyst of the mesentery is rare even in the endemic regions. Thus, it's important to differentiate hydatid disease of abdomen from the other cystic lesions, occured in the abdominal cavity, specially in the endemic regions.
PubMed: 36115120
DOI: 10.1016/j.ijscr.2022.107592 -
Journal of Surgical Case Reports Sep 2022Mesenteric cysts are uncommon benign abdominal tumors that may extend from the root of the mesenteric layers of the gastrointestinal tract into the retroperitoneum or...
Mesenteric cysts are uncommon benign abdominal tumors that may extend from the root of the mesenteric layers of the gastrointestinal tract into the retroperitoneum or the peritoneal cavity; they are usually asymptomatic and often represent an occasional finding. Definitive diagnosis is confirmed by the surgical intraoperative view and by histopathological examination. Surgical excision of the cyst is the treatment of choice. We present a case of a female patient who presented with back pain and a palpable abdominal mass. Due to large size of the mass and its contiguity with midline, patient underwent an hybrid combined surgical technique, with a first open phase followed by a laparoscopic excision. Complete surgical removal of the cyst was successfully performed without bowel resection, intraoperative spillage of cystic content and without morbidity. Histopathology confirmed diagnosis of simple mesenteric cyst. We strongly recommend a combined approach whenever a large intraperitoneal benign cystic lesion has been diagnosed.
PubMed: 36101714
DOI: 10.1093/jscr/rjac397 -
Cureus Jul 2022Chylous mesenteric cysts represent a subgroup of uncommon, mostly benign intra-abdominal masses often identified incidentally on radiographs. Diagnosis is often...
Chylous mesenteric cysts represent a subgroup of uncommon, mostly benign intra-abdominal masses often identified incidentally on radiographs. Diagnosis is often challenging because these lesions cannot be reliably distinguished from hematomas or other cystic lesions without direct tissue sampling. In addition, data remains scarce regarding nonsurgical diagnostic and therapeutic options for these cysts. This case describes an endoscopic option for a uniquely located chylous cyst.
PubMed: 36039205
DOI: 10.7759/cureus.27284 -
The Pan African Medical Journal 2022Cystic lymphangioma is a benign tumour that occurs secondary to obstruction of lymphatic channels. Its appearance in the paediatric age group is quite common, but...
Cystic lymphangioma is a benign tumour that occurs secondary to obstruction of lymphatic channels. Its appearance in the paediatric age group is quite common, but adulthood presentation is infrequent. Common locations are head and neck areas, whereas intra-abdominal occurrence is rare. To date, a few retroperitoneal cystic lymphangioma cases have been reported. A pre-operative clinical detection is always confusing, and most often, the diagnosis rests over the intraoperative findings and histopathological examination. The cyst's complete surgical resection remains the treatment of choice in patients with bulky, rapidly growing lesions or symptoms. Herein, we report a large retroperitoneal cystic lymphangioma that mimicked the mesenteric cyst clinically.
Topics: Adult; Child; Humans; Lymphangioma, Cystic; Mesenteric Cyst; Mesentery; Retroperitoneal Neoplasms
PubMed: 36034010
DOI: 10.11604/pamj.2022.42.115.30777 -
African Journal of Paediatric Surgery :... 2022Duodenal duplication cysts are a rare subtype of alimentary tract duplications cysts, consisting of 7% of all the duplications. We report a rare case of neonatal...
Duodenal duplication cysts are a rare subtype of alimentary tract duplications cysts, consisting of 7% of all the duplications. We report a rare case of neonatal duodenal duplication cyst presenting as a palpable abdominal mass and features of gastric outlet obstruction. A 27-day-old male child presented with complaints of icterus, non-bilious vomiting after every feed and right-sided abdominal lump for the last 15 days. A computed tomography scan of the abdomen revealed well-defined peripherally enhancing cystic lesion noted in the subhepatic region extending up to the right lumbar region. On surgical exploration, a cystic mass was found attached to the pyloric part of the stomach along the mesenteric border of the first, second and third part of the duodenum, which was marsupialised, and no communication was found with the duodenum. On histopathological analysis, a duodenal duplication cyst was diagnosed without any heterotopic mucosa. The literature was reviewed and the approach to duodenal duplication cyst in neonates is discussed.
Topics: Cysts; Duodenal Diseases; Duodenum; Humans; Infant, Newborn; Male; Stomach; Tomography, X-Ray Computed
PubMed: 36018210
DOI: 10.4103/ajps.ajps_176_21