P1588 - Mesenteric Cyst: A Rare Case of Recurrence Following Surgical Excision

Shunsa Tarar, DO¹, Ahmad Abulawi, MD², Osama Alshakhatreh, MD¹, Maria Faraz, MD¹, Asra Batool, MD^1
1Albany Medical Center, Albany, NY; ²Albany Medical College, Albany, NY

Introduction: Mesenteric cysts are defined as cysts located within the mesentery anywhere from the duodenum to rectum and may extend into the retroperitoneum. Most are discovered incidentally on imaging; typically in younger patients. The etiology remains unknown, the most accepted theory proposes that they develop as ectopic proliferation of the lymphatics within the mesentery that are not connected with the lymphatic system. We present a case of recurrence of a mesenteric cyst following surgical excision in a young female.

Case Description/Methods: The patient is a 35 year old female presenting with abdominal pain with incidental finding of mesenteric cyst on MRI. Exploratory surgery was done with total cystectomy of a sigmoid mesenteric cyst. She experienced persistent abdominal pain with repeat imaging done two years later revealing recurrence of mesenteric cyst. The patient underwent laparotomy and total abdominal hysterectomy with bilateral salpingectomy, but the cyst was not located during the procedure. Several years later, the patient presented with chronic abdominal pain. CT abdomen revealed a lobulated fluid collection measuring 6.8x3.6x10.6cm anterior to the left psoas muscle at the L3-L4 level, appearing distinct from adjacent small bowel. MRI revealed well-circumscribed loculated thin-walled T2 bright, cystic lesion anterior lateral to the left kidney with primary differential of mesenteric cyst versus lymphangioma. The patient requested removal of the cyst. During surgery the cyst was found near the ligament of Treitz with adherence to the mesentery. A lobulated single mesenteric cyst was resected entirely with an intact capsule. Pathological examination revealed the appearance of a tan-white, fluid-filled unilocular intact cyst filled with 20-30cc of clear fluid; findings consistent with benign mesenteric cyst.

Discussion: Mesenteric cysts are rare benign intra-abdominal tumors with an incidence of 1/250,000 hospital admissions. Recurrence of mesenteric cysts is low, approximately 0-15%. Following complete excision, recurrence is seen in about 6% of cases, mostly with retroperitoneal cysts or incomplete excision due to adhesion to surrounding structures.

This rare case demonstrates complete cystectomy of an uncomplicated sigmoid mesenteric cyst with a rare recurrence at the duodenojejunal flexure mesentery.

Complete cystectomy is the gold standard for treatment to prevent complications and recurrence.



Disclosures:


Shunsa Tarar, DO¹, Ahmad Abulawi, MD², Osama Alshakhatreh, MD¹, Maria Faraz, MD¹, Asra Batool, MD¹. P1588 - Mesenteric Cyst: A Rare Case of Recurrence Following Surgical Excision, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.