True about mesenteric cysts is –
Correct Answer: Enucleation is the treatment of choice of chylolymphatic cyst
Description: Mesenteric cysts are of following types:
Chylolymphatic (most common)
simple (mesothelial)
Enterogenous
Urogenital remnan
Dermoid (teratomatous cyst)
Chylolymphatic cyst
Usually are congenital, resulting from developmental sequestration of lymphatics.
It is found most frequently in the mesentery of the ileum.
The cyst wall is thin, made up of connective tissue; lacks the muscular wall of enteric duplication cyst.
The cyst is not lined by mucosa.
It is filled with clear lymph or chyle.
A chylolymphatic cyst is almost invariably solitary, although in extremely rare cases, multiple cysts may be seen.
The cyst is more often unilocular than multilocular.
A chylolymphatic cyst has a blood supply independent of that of the adjacent intestine, and thus enucleation (resection) is possible without the need for resection of the gut.
Enterogenous cyst
Believed to be derived either from a diverticulum of the mesenteric border of the intestine which has become sequestered from the intestinal canal during embryonic life or from a duplication of the intestine.
An enterogenous cyst has a thicker wall than a chylolymphatic cyst, and it is lined by mucous membrane, sometimes ciliated.
The content is mucinous
The enterogenosu cyst and the adjacent bowel wall has a common blood supply, therefore, enucleation of the cyst is always done along with resection of the related portion of intestine followed by anastomosis.
Clinical features
painless abdominal swelling
the swelling moves freely in a plane at right angles to the attachment of the mesentery.
recurrent attacks of abdominal pain with or without vomiting due to obstructive symptoms.
acute abdominal pain due to
torsion of the mesentery containing cyst
rupture of cyst
hemorrhage into the cyst
infection of the cyst
Enucleation is the t/t of choice. An associated segment of bowel is removed along with enterogenous cyst. Other t/t modalities i.e. marsupialization, internal drainage, or aspiration are suboptimal and are almost always followed by recurrence.
Category:
Surgery
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