A Rare Cause of Acute Abdomen: Mesenteric Cyst Torsion

Abstract

Background: Mesenteric cysts are rarely seen in adults with an incidence rate of 1/100000. Despite being rare, these cysts can lead to life-threatening acute abdomen cases by causing complications such as bleeding, infection, torsion, rupture and intestinal obstruction. Although the causes of mesenteric cysts are not clear, it is thought to be caused by lymphatic duct obstruction, lymphatic node degeneration, lymphatic duct injury and mesenteric leaves fail to fuse. Congenital disorders, diverticulitis, pelvic surgery and inflammatory bowel disease are accused in the etiology. Ileum and jejunum are the most common locations (80%). Less frequently, they occur in other parts of the colon and transverse colon. Methods: Mesenteric tumors are benign in general. Their malignant degenerations are rare. Their typical sizes are between 5 and 30 cm. The cysts may have serous, chylous or hemorrhagic content. In this article, a 74-year-old patient admitted to our emergency service because of abdominal pain was discussed. Results: A 74-year-old female patient admitted to our emergency service with nausea, vomiting, abdominal pain and abdominal swelling complaints. The patient was describing an abdominal swelling, growing gradually for approximately 6 months. She had no history or family history in this regard. In the palpation test, a mass was palpated in the right lower quadrant. There were widespread abdominal guarding and rebound tenderness. The patient had no abnormal findings in the routine examinations. In the direct abdominal imaging, a dense gas appearance was present in the bowels, although no air-fluid level was observed. Computed tomography revealed a cystic lesion of 108x55 mm in size with thick septations in the pelvic region. No other pathology was identified in other abdominal organs. The patient was operated after performing the necessary preparations. There was a cystic mass lesion of chylous character with necrosis in patches ranging from the umbilicus to the pelvis in the abdomen. It was observed that the mass was originated and fed in the meso-ileum, and exposed to torsion around pedicle. The mesenteric cyst was totally excised without damage to adjacent organs. There was no complication in the postoperative period, and the patient was discharged on the 2ndpostoperative day. Conclusion: Mesenteric cysts are detected either by chance through the imaging techniques used for various reasons or when fatal complications such as infection, hemorrhage, volvulus, perforation, intestinal obstruction caused by mesenteric cysts occur in certain cases. Therefore, resection should be considered when a mesenteric cyst is identified, albeit accidentally. In this study, we want to remind the mesenteric cysts and complications when faced with acute abdomen, in line with the literature.