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Mesenteric cyst

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Mesenteric cyst refers to a cyst located in the mesentery with an epithelial lining. Most of them are benign lesions, mostly due to congenital malformation or ectopic lymphatic tissue development, but also due to abdominal trauma, lymphatic inflammatory obstruction or localized lymph node degeneration. Small cysts are generally asymptomatic and signs. When the cyst is enlarged to a certain extent, clinical symptoms such as abdominal distension and abdominal pain may occur. When the condition is mild, it is generally self-healing, no special treatment is needed; when the symptoms are serious, surgery should be performed in time.

Cause

Cause

(1) Causes of the disease

1. Embryonic or developmental cysts Most of these cysts are caused by dysplasia or congenital malformations.

2. Traumatic or acquired cysts After abdominal trauma or surgical trauma, if the mesenteric tissue is hemorrhagic, the hematoma is ruptured or the lymphatic vessels are ruptured, and the lymphatic fluid overflows, and the fibrous tissue wraps to form a cyst.

3. Neoplastic or neoplastic cysts are mainly benign and malignant cysts of the mesentery.

4. Infectious cysts are most common in tuberculous cysts, followed by fungal or parasitic cysts.

(two) pathogenesis

Mesenteric cysts are mostly single, a few are multiple, mostly located between the jejunum or ileum mesangium, close to the mesenteric margin of the intestine, about half of the mesenteric cysts are located in the ileum mesenteric, there are data showing that the most common sites of mesenteric cysts are as follows: ileum > jejunum > small mesenteric root > transverse colon > sigmoid colon.

The cysts are mostly single, single-atrial, occasionally multiple or multiple atrial cysts, the largest diameter of 25cm, the smallest 2cm, the largest can fill the entire abdominal cavity (8000ml liquid), a tension-free round or oval, close to the intestine Most of them are dumbbell-shaped, and there are common muscle layers and blood vessels in the adjacent intestines.

1. Congenital cysts: common intestinal cysts and mesenteric serous cysts, multiple diverticulous buds appear during embryonic development, and gradually disappear and disappear, if a bud remains, and digest The detachment of the tract leaves between the two leaves of the mesangium and gradually increases to form a mesenteric mesenteric cyst. The inner wall of the cyst is covered with secretory intestinal mucosa, so the cyst often contains colorless mucus; the cyst is mostly single and spherical. Or oval; cysts vary in size, ranging from a few centimeters to 20cm; cysts are most common in the small mesentery, often isolated from the intestinal lumen, serous cysts are more common in the transverse colon and sigmoid mesentery, more single hair, cyst wall covering The skin cells are yellow transparent syrup, but when they are blood or infected, they are dark red or pus. Mesenteric dermoid cysts are rare. They are composed of mature ectodermal tissues, which are spherical and the wall of the capsule is connective tissue. Contains skin attachments such as hair follicles, sebaceous glands and sweat glands. The capsule contains oily or semi-liquid substances.

2. Neoplastic cysts: mostly lymphangioma, which can be cystic or cavernous lymphangioma, often occurring in the ileum mesenteric or small mesenteric root, followed by the sigmoid mesenteric, the cause of lymphangioma is not fully understood, possibly Lymphatic dysplasia, or lymphoid tissue ectopic growth caused by lymphatic obstruction and dilatation, the tumor consists of numerous dilated lymphatic vessels, the size of the milky white cystic structure of varying sizes, ranging from a few millimeters to 10cm in diameter The wall of the capsule consists of a single layer of lymphatic endothelial cells and fibrous connective tissue. Occasionally, a small amount of smooth muscle fibers may be present. A small number of cyst walls may be accompanied by chronic inflammation or calcification. The capsule contains yellow transparent lymph or chyle solution, and bleeding may also be Bloody, in addition, there are reports of cystic leiomyoma, lymphatic endothelial cell tumor, lymphangiosarcoma and malignant teratoma, the latter two are mesenteric cystic malignant tumors, tumor cysts are rare, accounting for all mesenteric cysts. 3%.

3. Traumatic cysts: After abdominal trauma or surgical trauma, if the mesenteric tissue is hemorrhagic, the hematoma is ruptured or the lymphatic vessels are ruptured, the lymphatic fluid overflows, and the fibrous tissue wraps to form a cyst, which is characterized by often no cells in the cyst wall. Structure, or only a few epithelial cells and a large number of fibrous connective tissue, cysts formed by lymphatic fluid and a little blood polymerization are also called chylothorax.

4. Infectious cysts: Infectious cysts are most common in tuberculous cysts, followed by fungal or parasitic cysts. The formation of tuberculous cysts is caused by the liquefaction of mesenteric lymphatics. Some authors have reported mesenteric abscesses. In case, the formation of abscess can be caused by bacterial infection through the blood, lymphatic, intestinal origin and other ways to the mesentery, or due to mesenteric parasitic cysts or other benign cysts.

Examine

an examination

Small cysts are generally asymptomatic and signs. When the cyst is enlarged to a certain extent, a series of clinical signs and symptoms appear.

1. Abdominal mass and bloating: Abdominal bloating and touching the mass are the initial symptoms of the patient's performance and the main findings in the physical examination. The mass is painless and tender. When the cyst is bleeding or infected, the mass may have tenderness. The boundaries are clear or unclear, depending on the disease, but there are no clear lumps. The capsule is sexy or rubber-like. If the tumor is too large, the abdomen has a sense of vibration. The degree of activity is usually large and regular: since the mesenteric root fixed to the posterior abdominal wall is fixed from the upper left to the lower right and longitudinally, the activity of the mesenteric root cyst is large in the lateral direction and moves along the upper right to the lower left axis. The upper and lower activities are limited; if the cyst is located around the mesentery, the upper and lower and left and right activities are large. Larger cysts can cause abdominal distension, and the patient's abdominal circumference gradually increases. Giant cysts can be misdiagnosed as ascites. Small cysts can be manifested as abdominal distension on one side, and large cysts can cause abdominal distension in intestinal obstruction.

2. Abdominal pain: intermittent abdominal pain, repeated attacks. It is caused by the compression or twist of the intestine; the larger cyst squeezes the mesentery, which increases the tension of the mesentery and can also cause abdominal pain. The mesenteric cyst is located between the two layers of the mesentery. When the patient is active, the root of the mesentum may be pulled due to gravity or cause slight bowel in the intestine. Therefore, abdominal pain is a frequently occurring symptom. Mild abdominal pain can last from half an hour to several hours. In severe cases, it can be accompanied by fever, vomiting, and diarrhea. It lasts for several days and can relapse after remission.

3. Other manifestations: Because the mesenteric cyst is more free, the weight of the tumor is easy to cause intestinal torsion, and often causes acute intestinal obstruction. Huge cysts can cause chronic intestinal obstruction, and a small number of enlarged patients can produce local compression symptoms, such as compression of the gastrointestinal tract can cause paroxysmal abdominal pain, postprandial discomfort and loss of appetite, nausea and vomiting. Compression of the ureter can produce symptomatic or asymptomatic urinary tract obstruction. Individual patients may develop ascites due to rupture of the cyst. Corrosion of the cyst or invasion of the intestinal wall can cause blood in the stool. Patients can also show loss of appetite, weight loss, fever, nausea, vomiting, diarrhea, constipation and so on.

Other auxiliary inspections:

X-ray inspection

There is not necessarily a positive finding, but it can exclude urinary or intestinal diseases.

(1) Abdominal plain film: soft tissue shadow can be seen; when the skin cyst and the hydatid cyst wall are calcified, the ring calcification can be seen; the skin-like cyst can be seen in the structure of teeth and bones.

(2) barium meal or barium enema angiography: visible intestinal pressure displacement and other manifestations: such as the mass near the intestinal stenosis, elongation, intestinal wall stiffness; tincture through difficult or slow; stomach duodenum and transverse colon movement or curved Indentation and so on.

(3) CT scan: can provide the best diagnosis of cyst imaging, can provide a definite position, can be qualitative, and is conducive to the differential diagnosis of mesenteric cyst.

2.B-ultrasound

Abdominal B-ultrasound can not only be positioned, but also qualitative. Because of its simplicity and non-invasiveness, it can be followed up for observation. For pseudocysts, it can be used as a guide for conservative or surgical treatment. The sonogram of the mesenteric cyst has the following characteristics:

(1) Shape: a round or semi-circular mass.

(2) Boundary: Due to the complete capsule, the cyst image has a clear, sleek, sharp, and petal-like aura.

(3) Internal reflex: a dark area of the mesenteric area. The number and distribution of echogenic light clusters in the dark area of the liquid vary with the nature and distribution of the components of the cyst. For example, if the contents of the capsule are mainly liquid or a homogeneous clot formed mainly by shedding, the reflection interface Less, there is little or no internal echo on the sonogram; if the shedding is dispersed and suspended in the liquid, there are more echoes or spots, and the distribution is uneven.

(4) Sound passability: Sound passability varies depending on the liquid content of the contents. Those with more liquid components have stronger back wall reflection and good sound transmission; otherwise they show moderate or poor sound penetration.

(5) Compressibility: has obvious compressibility.

3. Laparoscopy

The location, size, etc. of the cyst can be directly observed.

Diagnosis

Differential diagnosis

Mesenteric tumors should be distinguished from ovarian cysts, pancreatic cysts, ascites, pedicled ureter fibroids, hydronephrosis, gallbladder effusion, migratory kidney and spleen cysts or tumors.