Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2017; 5(9): 360-363
Published online Sep 16, 2017. doi: 10.12998/wjcc.v5.i9.360
Conservative approach to the acute management of a large mesenteric cyst
Billy C Leung, Ruth Sankey, Matteo Fronza, Mohamed Maatouk
Billy C Leung, Ruth Sankey, Matteo Fronza, Mohamed Maatouk, Department of General and Colorectal Surgery, Milton Keynes Hospital, Eaglestone, Milton Keynes MK6 5LD, United Kingdom
Author contributions: Billy C Leung: Lead author and case report writer; Ruth Sankey: Literature search and content review; Matteo Fronza: Literature search and data collection (notes and radiographs); Mohamed Maatouk: Senior author, content review and guidance; all authors contributed significantly towards the completion of the case report.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Billy C Leung, MBBS, BSc, MRCS, MSc, DOHNS, Core Surgical Trainee, Department of General and Colorectal Surgery, Milton Keynes Hospital, H8 Standing Way, Eaglestone, Milton Keynes MK6 5LD, United Kingdom. billy-ching.leung@kcl.ac.uk
Telephone: +44-7771561978
Received: September 22, 2016
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
Abstract

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.

Keywords: Conservative management, Acute setting, Mesenteric cysts, Elective operation

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.