Vera De Matos, MD; Pierre Russo, MD; Holly Hedrick, MD; David A. Piccoli, MD; Petar Mamula, MDSeries Editors: David A. Piccoli, MD; Petar Mamula, MD


August 03, 2005

Diagnosis and Discussion

The differential diagnosis of the cystic mass found at laparoscopy included: (1) lymphangioma or cystic hygroma, and (2) mesenteric and omental cyst.

The final diagnosis was omental cyst.

Lymphangiomas are usually small lesions made of a network of endothelium-lined spaces filled with lymph, whereas cystic hygromas are larger masses with dilated spaces lined by endothelium and scant stroma, filled with lymph.

Mesenteric and omental cysts are benign uni- or multilocular cysts that originate after proliferation of ectopic or obstructed lymphatic channels resulting in fluid accumulation. Mesenteric cysts are more frequent than omental cysts; they may occur anywhere in the gastrointestinal tract, most often in the small bowel mesentery, and as multiple lesions. Omental cysts are freely movable, nontender, and often located in the midline; they tend to be large and may simulate ascites, mimic pancreatic cyst or a duodenal duplication, and are usually solitary. These cysts present with progressive abdominal distension, occasionally with abdominal pain, a palpable mass, or small bowel obstruction. Treatment is complete surgical resection of the cyst. Although rare, tumors and cystic lesions should be considered when there is ascites of unclear etiology.

The omental cyst was surgically removed. The patient is doing well and is symptom-free 3 years after the surgery.


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