Key clinical message
Mesenteric cysts are rare tumours that are difficult to diagnose given
their vague symptomatology such as abdominal pain and nausea. Our case
demonstrates a patient presenting with suspected ureteric colic, whereby
early imaging revealed this rarity.
A 24 year old female with no past medical history, presented with 2
weeks of left sided loin to groin pain. Nausea and dysuria were present
alongside microscopic haematuria. Blood tests were unremarkable. A
diagnosis of ureteric colic was made and urgent computed tomography (CT)
urogram was arranged. This demonstrated a large cystic mass across the
left hemiabdomen, measuring 23.7x11.7x11.6cm with mass effect on the
kidney and descending colon, suggestive of a giant mesenteric cyst
(Figure 1). Further surgical input was sought, and following magnetic
resonance scan of the abdomen, the patient underwent laparotomy for
excision of the lesion (Figure 2). Histology revealed fibrovascular
connective and adipose tissue with no malignancy present. There has been
no recurrence and a good recovery to date.
Mesenteric cysts are rare tumours that occur from duodenum to rectum,
with an incidence reported as 1 in 3000001. Their
pathophysiology is thought to be due to lymphatic and mesenteric
embryological malformation1. Malignant transformation
is uncommon but complications include perforation, haemorrhage and
peritonitis2. Diagnosis is difficult due to vague
symptoms with more common underlying causes. Hence imaging is essential
in cases of diagnostic uncertainty. Treatment is via surgical excision,
ensuring clear resection margins to avoid recurrence2.