mesenteric cyst
Introduction
Introduction to mesenteric cyst The mesenteric cyst is the mesenteric lymphatic vessel that is enlarged and cystized, so it is also called the mesenteric chyle cyst. The cause may be congenital lymphatic wall dysplasia to make lymphatic tumors tumor-like changes, but also due to abdominal trauma, inflammation, surgery and other factors leading to lymphatic adhesions, obstruction, poor lymph flow, stasis, and gradually form cysts. It is also thought that the collaterals between the lymphatic vessels and the lymphatic vessels, lymphatic vessels and veins are occluded, so that the rich collaterals do not allow the lymph fluid to flow smoothly, leading to cyst formation. Cysts can be single or multiple, containing chylorrhea, or mixed with a small amount of blood and cellulose, a lot of serous, cyst wall composed of epithelial cells and connective tissue, about 60% of mesenteric cysts in the small mesentery, 24% The mesentery of the colon is 16% behind the retroperitoneum. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: intestinal obstruction, urinary tract obstruction
Cause
Mesenteric cyst etiology
(1) Causes of the disease
1. Embryonic or developmental cysts Most of these cysts are caused by dysplasia or congenital malformations.
2. Traumatic or acquired cysts After abdominal trauma or surgical trauma, if the mesenteric tissue is hemorrhagic, the hematoma is ruptured or the lymphatic vessels are ruptured, and the lymphatic fluid overflows, and the fibrous tissue wraps to form a cyst.
3. Neoplastic or neoplastic cysts are mainly benign and malignant cysts of the mesentery.
4. Infectious cysts are most common in tuberculous cysts, followed by fungal or parasitic cysts.
(two) pathogenesis
Mesenteric cysts are mostly single, a few are multiple, mostly located between the jejunum or ileum mesangium, close to the mesenteric margin of the intestine, about half of the mesenteric cysts are located in the ileum mesenteric, there are data showing that the most common sites of mesenteric cysts are as follows: ileum > jejunum > small mesenteric root > transverse colon > sigmoid colon (Table 1).
The cysts are mostly single, single-atrial, occasionally multiple or multiple atrial cysts, the largest diameter of 25cm, the smallest 2cm, the largest can fill the entire abdominal cavity (8000ml liquid), a tension-free round or oval, close to the intestine Most of them are dumbbell-shaped, and there are common muscle layers and blood vessels in the adjacent intestines.
1. Congenital cysts: common intestinal cysts and mesenteric serous cysts, multiple diverticulous buds appear during embryonic development, and gradually disappear and disappear, if a bud remains, and digest The detachment of the tract leaves between the two leaves of the mesangium and gradually increases to form a mesenteric mesenteric cyst. The inner wall of the cyst is covered with secretory intestinal mucosa, so the cyst often contains colorless mucus; the cyst is mostly single and spherical. Or oval; cysts vary in size, ranging from a few centimeters to 20cm; cysts are most common in the small mesentery, often isolated from the intestinal lumen, serous cysts are more common in the transverse colon and sigmoid mesentery, more single hair, cyst wall covering The skin cells are yellow transparent syrup, but when they are blood or infected, they are dark red or pus. Mesenteric dermoid cysts are rare. They are composed of mature ectodermal tissues, which are spherical and the wall of the capsule is connective tissue. Contains skin attachments such as hair follicles, sebaceous glands and sweat glands. The capsule contains oily or semi-liquid substances.
2. Neoplastic cysts: mostly lymphangioma, which can be cystic or cavernous lymphangioma, often occurring in the ileum mesenteric or small mesenteric root, followed by the sigmoid mesenteric, the cause of lymphangioma is not fully understood, possibly Lymphatic dysplasia, or lymphoid tissue ectopic growth caused by lymphatic obstruction and dilatation, the tumor consists of numerous dilated lymphatic vessels, the size of the milky white cystic structure of varying sizes, ranging from a few millimeters to 10cm in diameter The wall of the capsule consists of a single layer of lymphatic endothelial cells and fibrous connective tissue. Occasionally, a small amount of smooth muscle fibers may be present. A small number of cyst walls may be accompanied by chronic inflammation or calcification. The capsule contains yellow transparent lymph or chyle solution, and bleeding may also be Bloody, in addition, there are reports of cystic leiomyoma, lymphatic endothelial cell tumor, lymphangiosarcoma and malignant teratoma, the latter two are mesenteric cystic malignant tumors, tumor cysts are rare, accounting for all mesenteric cysts. 3%.
3. Traumatic cysts: After abdominal trauma or surgical trauma, if the mesenteric tissue is hemorrhagic, the hematoma is ruptured or the lymphatic vessels are ruptured, the lymphatic fluid overflows, and the fibrous tissue wraps to form a cyst, which is characterized by often no cells in the cyst wall. Structure, or only a few epithelial cells and a large number of fibrous connective tissue, cysts formed by lymphatic fluid and a little blood polymerization are also called chylothorax.
4. Infectious cysts: Infectious cysts are most common in tuberculous cysts, followed by fungal or parasitic cysts. The formation of tuberculous cysts is caused by the liquefaction of mesenteric lymphatics. Some authors have reported mesenteric abscesses. In case, the formation of abscess can be caused by bacterial infection through the blood, lymphatic, intestinal origin and other ways to the mesentery, or due to mesenteric parasitic cysts or other benign cysts.
Prevention
Mesenteric cyst prevention
If the disease is caused by the original disease (abdominal trauma or surgical trauma, infectious tuberculosis cysts, etc.), the primary disease is treated to prevent mesenteric cysts.
Complication
Mesenteric cyst complications Complications, intestinal obstruction, urinary tract obstruction
1. Intestinal obstruction due to the weight of the tumor, so that the mesenteric and intestinal tube torsion caused acute intestinal obstruction; huge cysts squeeze the intestine can cause chronic intestinal obstruction.
2. Urinary tract obstruction A large cyst compresses the ureter and can produce symptomatic or asymptomatic urinary tract obstruction.
Symptom
Mesenteric cyst symptoms Common symptoms Nausea and vomiting Diarrhea Abdominal pain Abdominal mass constipation Swelling paroxysmal abdominal pain Liver nausea Ascites
Small cysts are generally asymptomatic and physical signs. When the cysts increase to a certain extent, a series of clinical symptoms and signs appear.
1. Abdominal mass and abdominal distension The abdominal swelling and touching the mass are the initial symptoms of the patient's performance. They are also the main findings in the physical examination. The mass has no pain and tenderness. When the cyst is bleeding or infected, the mass may have tenderness and the boundary is clear. Or unclear, depending on the disease, but there is no clear lumps border, there is a sac sexy or rubber-like, if the tumor is too large, the abdomen has a sense of vibration, the activity is usually large, and has regularity: due to fixation The mesenteric root in the posterior abdominal wall is from the upper left to the lower right and is longitudinally fixed. Therefore, the activity of the mesenteric root cyst is large in the lateral direction, and moves along the right upper to lower left axis, while the upper and lower activities are restricted (Fig. 1); if the cyst is located Around the mesentery, the range of motion is up and down and left and right.
Larger cysts can cause abdominal distension, and the patient's abdominal circumference gradually increases. Giant cysts can be misdiagnosed as ascites. Small cysts can be manifested as abdominal distension on one side, and large cysts can cause abdominal distension in intestinal obstruction.
2. Abdominal pain is intermittent abdominal pain, recurrent, caused by compression or torsion of the intestine; larger cysts squeeze the mesentery, increase the tension of the mesentery, can also cause abdominal pain symptoms, mesenteric cyst is located between the two layers of mesentery When the patient is active, the root of the mesentery may be pulled due to gravity or the bowel may be slightly paralyzed. Therefore, abdominal pain is a frequent symptom. Mild abdominal pain can last for half an hour to several hours. In severe cases, it may be accompanied by fever, vomiting, diarrhea, and persistence. After a few days, it can relapse after remission.
3. Other manifestations Because mesenteric cysts are more free, the weight of the tumor is easy to cause intestinal torsion, and often lead to acute intestinal obstruction, huge cysts can cause chronic intestinal obstruction, a small number of enlarged patients can produce local compression symptoms, such as Compression of the gastrointestinal tract can cause paroxysmal abdominal pain, postprandial discomfort and loss of appetite, nausea and vomiting, etc., compression of the ureter, can produce symptomatic or asymptomatic urinary tract obstruction.
Examine
Examination of mesenteric cysts
In acute abdomen, most patients may have an increase in the number of peripheral white blood cells.
1. X-ray examination does not necessarily have a positive finding, but can exclude urinary or intestinal diseases.
(1) Abdominal plain film: soft tissue shadow can be seen; when the skin cyst and the hydatid cyst wall are calcified, the ring calcification can be seen; the skin-like cyst can be seen in the structure of teeth and bones.
(2) barium meal or barium enema: visible intestinal compression and other manifestations: such as the tumor adjacent to the intestinal stenosis, elongated, intestinal wall stiffness; tincture through difficult or slow; stomach duodenum and transverse colon movement or curved Indentation and so on.
(3) CT scan: can provide the best cyst imaging diagnosis, can provide a certain position, and can be qualitative, which is conducive to the differential diagnosis of mesenteric cyst.
2. B-ultrasound abdominal B-ultrasound can not only be positioned, but also qualitative, because of simple, non-invasive, can be used for follow-up observation, for pseudocyst, can be used as a guide for conservative treatment or surgical treatment, the sonogram of mesenteric cyst is as follows Features:
(1) Shape: a round or semi-circular mass.
(2) Boundary: Due to the complete capsule, the cyst image has a clear, sleek, sharp, and petal-like aura.
(3) Internal reflex: the dark area of the mesenteric area, and the distribution and distribution of the echogenic light group in the liquid dark area, which varies depending on the traits and distribution of the contents of the cyst, such as the contents of the capsule are mainly liquid or mainly A homogeneous clot formed by the detachment, because there is less reflection interface, there is little or no internal echo on the sonogram; if the detachment is dispersed and suspended in the liquid, there are more echoes or spots. The distribution is uneven.
(4) Acoustic traversability: Acoustic traversability varies depending on the liquid content of the content. If the liquid component is more, the back wall reflects stronger and the sound penetration is better; otherwise, the sound is moderate or poor. Sex.
(5) Compressibility: has obvious compressibility.
3. Laparoscopy can directly observe the location and size of the cyst.
Diagnosis
Diagnosis and differentiation of mesenteric cyst
Individual patients may develop ascites due to cyst rupture. Corrosion of the cyst or invasion of the intestinal wall may cause blood in the stool. Patients may also show loss of appetite, weight loss, fever, nausea, vomiting, diarrhea, constipation, etc.
The diagnosis of mesenteric cysts relies mainly on clinical manifestations and the above-mentioned auxiliary examinations.
Mesenteric tumors should be distinguished from ovarian cysts, pancreatic cysts, ascites, pedicled ureter fibroids, hydronephrosis, gallbladder effusion, peritoneal tongue tumors, kidney and spleen cysts or tumors.
