Serena Thomas, Gao Raisa, Dinnan Kelly
Beaumont Health Farmington Hills, Department of General Surgery, 28050 Grand River Avenue, Farmington Hills, MI, 48336, USA.
Int J Surg Case Rep. 2020;66:96-100. doi: 10.1016/j.ijscr.2019.10.041. Epub 2019 Oct 29.
Mesenteric psuedocysts are rare tumors of the gastrointestinal mesentery that are seldom symptomatic. Although these benign tumors are most commonly found incidentally during work-up for other pathology, they can be troublesome in select patients based off size, location and risk of malignant transformation. This case is reported in accordance with SCARE Criteria [1].
A 24 year-old-male presents with life-long migratory abdominal pain presents with a one week history of acute pain associated with nausea. Computed tomography revealed free fluid in the pelvis and a thin-walled mesenteric cyst within the left, mid-abdominal mesentery measuring approximately 4.3 × 4.0 × 4.0 cm. The patient was admitted for resuscitation and planned delayed operative intervention.
The patient underwent complete open enucleation secondary to location and in an attempt to limit injuries to or resection of small bowel. Pathological analysis revealed a mesenteric cyst with fluid culture positive for Propionibacterium acnes without true cystic wall consistent with an infected mesenteric pseudocyst. These lesions are difficult to diagnose secondary to varied presentation and lack of pathognomonic clinical, laboratory and imaging findings. Mesenteric pseudocyst have a low rate of recurrence after removal; however, surgical management is mandated due to risks of malignant transformation.
This is a rare case of a mesenteric pseudocyst of small size presenting with lifelong abdominal pain secondary to its location near the root of the mesentery and inflammatory reaction secondary to infection. It is important to maintain a high index of suspicion for mesenteric cyst as many complications may result if misdiagnosed or without proper surgical management.
肠系膜假性囊肿是胃肠道系膜的罕见肿瘤，很少有症状。虽然这些良性肿瘤最常在因其他病理情况进行检查时偶然发现，但根据大小、位置和恶变风险，在某些患者中可能会造成麻烦。本病例报告符合SCARE标准[1]。
一名24岁男性，有终生转移性腹痛，现出现伴有恶心的一周急性疼痛病史。计算机断层扫描显示盆腔有游离液体，左中腹部肠系膜内有一个薄壁肠系膜囊肿，大小约为4.3×4.0×4.0厘米。患者入院进行复苏，并计划进行延迟手术干预。
由于囊肿位置以及为了尽量减少对小肠的损伤或切除，患者接受了完全开放性摘除术。病理分析显示为肠系膜囊肿，液体培养痤疮丙酸杆菌呈阳性，无真正的囊肿壁，符合感染性肠系膜假性囊肿。这些病变因表现多样且缺乏特征性的临床、实验室和影像学表现而难以诊断。肠系膜假性囊肿切除后复发率低；然而，由于存在恶变风险，仍需进行手术治疗。
这是一例罕见的小尺寸肠系膜假性囊肿病例，因其位于肠系膜根部附近以及感染继发的炎症反应而出现终生腹痛。对肠系膜囊肿保持高度怀疑很重要，因为如果误诊或未进行适当的手术治疗，可能会导致许多并发症。
