Published online Sep 16, 2017. doi: 10.12998/wjcc.v5.i9.360
Peer-review started: September 23, 2016
First decision: November 2, 2016
Revised: April 30, 2017
Accepted: June 6, 2017
Article in press: June 8, 2017
Published online: September 16, 2017
Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large (21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.
Core tip: Mesenteric cysts are often asymptomatic and present as an incidental finding, and acute operative removal is usually performed on symptomatic cases. However for selected cases, an initial conservative approach followed by planned elective surgery can be opted for, particularly in the absence of peritonitis and bowel obstruction. A safer and planned elective procedure would reduce the risk of operative complications. Acute drainage of the cyst should also be avoided due to the high risk of recurrence and infection.