Mesenteric cysts are rare growths found within the mesentery, the specialized tissue that anchors the intestines to the abdominal wall. While often benign, meaning non-cancerous, these masses can lead to complications, making them dangerous. This article explores the nature of mesenteric cysts and when they can pose a threat to health.
Understanding Mesenteric Cysts
Mesenteric cysts are uncommon, with an estimated incidence of 1 case per 100,000 to 250,000 hospital admissions. They can develop anywhere along the gastrointestinal tract’s mesentery, most frequently in the small bowel. These cysts vary significantly in size, from a few millimeters to several centimeters, and may contain different types of fluid, such as serous, chylous, or hemorrhagic.
The exact origin of mesenteric cysts is not fully understood, but several theories exist. Some theories suggest they arise from congenital malformations, such as the abnormal development or blockage of lymphatic vessels. Other proposed causes include trauma, infection, or degeneration of lymph nodes. While most are benign, less than 3% can be malignant or have malignant potential.
When Mesenteric Cysts Become Dangerous
While many mesenteric cysts remain asymptomatic, they become problematic or dangerous when they grow large or lead to complications. One such complication is intestinal obstruction, where the cyst’s size or location can compress or twist the intestines, blocking food passage. This can result in severe abdominal pain, nausea, and vomiting.
Another serious concern is the potential for a cyst to rupture, although this is rare. Rupture can occur due to trauma or increased internal pressure, leading to fluid leakage into the abdominal cavity and causing peritonitis, a painful inflammation of the abdominal lining. Cysts can also become infected, potentially leading to an abscess, causing localized pain, fever, and general unwellness.
Bleeding into the cyst, known as hemorrhage, can rapidly increase its size and cause sudden pain. Additionally, a mesenteric cyst can undergo torsion, twisting on its stalk and cutting off its blood supply. This causes intense, sudden abdominal pain and requires immediate medical attention. Malignant transformation, though extremely rare, is also a concern.
Symptoms and Diagnosis
Mesenteric cysts often cause no symptoms until they grow large enough to create pressure or lead to complications. When symptoms do occur, they are varied and non-specific. Common complaints include abdominal pain, ranging from vague discomfort to sharp pain, and a palpable abdominal mass. Other symptoms can include nausea, vomiting, constipation, or diarrhea.
Due to their non-specific nature, mesenteric cysts are frequently discovered incidentally during imaging studies for other reasons. Diagnosis typically involves ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI). These methods help identify the cyst’s size, location, and internal characteristics. A thorough medical history and physical examination also aid diagnosis.
Treatment and Outlook
The primary approach to managing mesenteric cysts involves surgical removal, particularly for symptomatic cysts or those posing a risk of complications. The goal of surgery is complete excision to prevent recurrence. Surgical options include both laparoscopic (minimally invasive) and open techniques, chosen based on the cyst’s size, location, and complexity. In some cases, if the cyst involves bowel blood vessels, a portion of the bowel may also need to be removed.
Following successful surgical removal, the outlook for individuals with benign mesenteric cysts is generally very favorable. Recurrence is rare, averaging around 6.1%. Prognosis largely depends on whether the cyst was benign or, in very rare instances, malignant. For rare malignant cases, the outlook is determined by the specific type of cancer and its stage.