True about mesenteric cysta) Moves perpendicular to the line of attachmentb) Teratomatous is most commonc) Chylolymphatic cyst has separate blood supplyd) Surgical removal of bowel along cyst is treatment of choice in all the cyst
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. Cyst wall is thin, made up of connective tissue; lacks the muscular wall of enteric duplication cyst. Cyst is not lined by mucosa. It is filled with clear lymph or chyle. A chylolymphatic cyst is almost invariably solitary, although in extreme rare cases, multiple cyst may be seen. 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 gut. Enterogenous cyst Believed to be derived either from a diveiculum 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 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 poion 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. 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.
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G.I.T