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Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report

INTRODUCTION: 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 ma...

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Autores principales: Serena, Thomas, Gao, Raisa, Dinnan, Kelly
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906687/
https://www.ncbi.nlm.nih.gov/pubmed/31821982
http://dx.doi.org/10.1016/j.ijscr.2019.10.041
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author Serena, Thomas
Gao, Raisa
Dinnan, Kelly
author_facet Serena, Thomas
Gao, Raisa
Dinnan, Kelly
author_sort Serena, Thomas
collection PubMed
description INTRODUCTION: 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]. PRESENTATION OF CASE: 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. DISCUSSION: 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. CONCLUSION: 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.
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spelling pubmed-69066872019-12-20 Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report Serena, Thomas Gao, Raisa Dinnan, Kelly Int J Surg Case Rep Article INTRODUCTION: 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]. PRESENTATION OF CASE: 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. DISCUSSION: 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. CONCLUSION: 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. Elsevier 2019-10-29 /pmc/articles/PMC6906687/ /pubmed/31821982 http://dx.doi.org/10.1016/j.ijscr.2019.10.041 Text en © 2019 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Serena, Thomas
Gao, Raisa
Dinnan, Kelly
Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report
title Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report
title_full Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report
title_fullStr Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report
title_full_unstemmed Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report
title_short Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—A case report
title_sort open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain—a case report
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906687/
https://www.ncbi.nlm.nih.gov/pubmed/31821982
http://dx.doi.org/10.1016/j.ijscr.2019.10.041
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