Mesenteric Cyst Surgery

Mesenteric cysts are rare intraabdominal cystic lesions arising from the mesentery of the small bowel (most common at the ileum) or large bowel. Histopathologic classification (de Perrot) includes lymphatic origin (lymphangioma, simple lymphatic), mesothelial origin (mesothelial cyst, benign cystic mesothelioma), enteric duplication, urogenital remnant, dermoid (mature teratoma), pseudocyst (post-traumatic, infectious) and rare malignant cysts (cystic mesothelioma, cystic lymphangiosarcoma).

Most patients present with vague abdominal symptoms (fullness, bloating, intermittent pain) or are diagnosed incidentally on imaging (US, CT, MRI). Larger cysts may cause palpable mass, mechanical bowel obstruction, volvulus, hemorrhage, infection or peritonitis from rupture. Differential diagnosis includes ovarian cyst, omental cyst, intestinal duplication and cystic neoplasms.

Surgical principles include complete cyst enucleation when feasible (preserving bowel) or segmental bowel resection when the cyst is closely adherent or supplied by mesenteric vessels. Laparoscopic and robotic approaches are increasingly used. Frozen section and final histology guide further management; malignant cysts may require additional oncologic resection and adjuvant therapy.