The diagnosis and treatment of a symptomatic mesenteric cyst.

To cite: Rajendran S, Khan A, Murphy M, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-202410 DESCRIPTION The diagnosis and treatment of mesenteric cysts is challenging due to rarity, lack of specific symptoms and variability in location and size. This report aims to discuss current diagnostic and treatment strategies. A 35-year-old woman presented with non-specific abdominal pain. CT revealed a 5×5×3 cm septated abdominal cyst (figure 1). Aspiration (figure 1) demonstrated no malignant cells. Return of symptoms confirmed recurrence using MRI 2 months later (figure 2). Laparotomy confirmed 5 cm cyst attached to ileal mesentery (figure 3). Cyst was excised intact (figure 3). Histology showed multilocular cyst lined by mullerian epithelium. Symptoms resolved with no evidence of recurrence 3 months later (figure 1). Mesenteric cysts, described by Benevenni in 1507, arise from duodenal to sigmoid mesentery. They generally cause non-specific symptoms or rarely rupture, tort and obstruct. They result from lymphatic malformation, occult trauma or infection. Differential diagnosis includes ovarian, duplication or pseudocysts. Careful interpretation of imaging is important for preoperative planning. Ultrasound can be useful as primary imaging modality. Although CT was performed in our case, taking into account the age of the female patient, MRI is advised for further anatomic localisation and guidance for aspiration. Treatment is indicated for symptoms. While there is lack of evidence correlating size with complications it is likely that increasing size will increase the risk of complications.