Increased abdominal circumference
Introduction
Introduction Mesenteric cysts are generally asymptomatic and signs, and larger cysts can cause abdominal distension, and the patient's abdominal circumference gradually increases. Mesenteric cyst is a mesenteric chyle cyst that is caused by enlargement of the mesenteric lymphatic vessels and cystization. The cause may be congenital lymphangiogenesis and lymphangiogenesis. It can also cause lymphatic adhesions, obstruction, poor flow of lymph fluid, stasis, and gradually form cysts due to abdominal trauma, inflammation, surgery and other factors. 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. The cyst may be single or multiple, containing chyle, or mixed with a small amount of blood and cellulose, a lot of serous, the cyst wall consists of epithelial cells and connective tissue. About 60% of mesenteric cysts are located in the small mesentery, 24% in the mesenteric membrane, and 16% in the retroperitoneum.
Cause
Cause
(1) Causes of the disease
Embryonic or developmental cyst
Most of this type of cyst is due to dysplasia or congenital malformation.
2. Traumatic or acquired cysts
After abdominal trauma or surgical trauma, if the mesenteric tissue is hemorrhagic, hematoma or lymphatic rupture, lymphatic overflow, and wrapped by fibrous tissue can form a cyst.
3. Neoplastic or neoplastic cysts
Mainly for the benign and malignant cysts of the mesentery.
4. Infectious cysts
Tuberculous cysts are most common in infectious cysts, followed by fungal or parasitic cysts.
(two) pathogenesis
Mesenteric cysts are mostly single and a few are multiple. Mostly located between the jejunum or ileum mesangium, close to the mesenteric margin of the intestine, of which about half of the mesenteric cyst is located in the ileum mesentery. Data show that the predilection sites of mesenteric cysts are arranged as follows: ileum > jejunum > small mesenteric root > transverse colon > sigmoid colon (Table 1).
Most of the cysts are 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 dumbbells. There are common muscle layers and blood vessels in the adjacent intestines, and many tumors cannot be removed alone.
1. Congenital cysts: Commonly, intestinal cysts and mesenteric serous cysts. During the embryonic development of the intestine, a number of diverticulum-like buds appeared and gradually disappeared. If a bud suddenly remains and falls off the digestive tract, it remains between the two leaves of the mesangium and gradually grows 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, spherical or elliptical; cysts vary in size from several centimeters to 20 cm; cysts are most common in the small intestine Membrane, often isolated from the intestinal lumen. Serous cysts often occur in the transverse colon and sigmoid mesenteric membrane, more than a single hair, the wall of the capsule covers the mesothelial cells, the capsule is a yellow transparent slurry, but when it is blood or infected, it is dark red or pus. Mesenteric dermoid cyst is rare and is composed of mature ectodermal tissue. It is spherical and the wall of the capsule is connective tissue. It can contain 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 occurs in the ileum mesenteric or small mesenteric root, followed by the sigmoid mesenteric membrane. The cause of lymphangioma is not fully understood, and may be abnormal lymphatic development. Or lymphoid tissue ectopic growth caused by lymphatic obstruction and expansion. The tumor consists of a myriad of expanded lymphatic vessels with a milky white saclike structure of varying sizes ranging from a few millimeters to 10 cm 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. A small number of cyst walls can be complicated by chronic inflammation or calcification. The capsule contains yellow transparent lymph or chyle, which may be bloody. In addition, there are reports of cystic leiomyoma, lymphatic endothelial cell tumor, lymphangisarcoma and malignant teratoma, the latter two are mesenteric cystic malignancies. Tumor cysts are rare, accounting for about 3% of all mesenteric cysts.
3. Traumatic cysts: After abdominal trauma or surgical trauma, if the mesenteric tissue is hemorrhagic, hematoma or lymphatic rupture, lymphatic overflow, and wrapped by fibrous tissue can form cysts. It is characterized in that the wall of the capsule often has no cellular structure, or only a few epithelial cells and a large number of fibrous connective tissue. A cyst formed by lymphatic fluid and a little blood polymerization is also called a chylomicron cyst.
4. Infectious cysts: Tuberculous cysts are most common in infectious cysts, followed by fungal or parasitic cysts. The formation of tuberculous cysts is caused by the liquefaction of mesenteric lymphatics. There are cases in the country that report mesenteric abscess. The formation of abscess can be caused by bacterial infection through the blood, lymphatic, and intestinal origin to the mesentery. It can also be caused by a concomitant mesenteric parasitic cyst or other benign cyst.
Examine
an examination
Related inspection
Gastrointestinal CT examination of abdominal plain film
Small cysts are generally asymptomatic and signs. When the cyst is enlarged to a certain extent, a series of clinical signs and symptoms appear.
Abdominal mass and bloating
Abdominal bloating and touching the mass are the initial symptoms of the patient's performance and are the main findings in the physical examination. The mass is painless and tender. When the cyst is bleeding or infected, the mass may have tenderness. The boundaries are clear or unclear, depending on the disease, but there are no clear lumps. The capsule is sexy or rubber-like. If the tumor is too large, the abdomen has a sense of vibration. The degree of activity is usually large and regular: since the mesenteric root fixed to the posterior abdominal wall is fixed from the upper left to the lower right and longitudinally, the activity of the mesenteric root cyst is large in the lateral direction and moves along the upper right to the lower left axis. The upper and lower activities are limited; if the cyst is located around the mesentery, the upper and lower and left and right activities are large.
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
For intermittent abdominal pain, repeated attacks. It is caused by the compression or twist of the intestine; the larger cyst squeezes the mesentery, which increases the tension of the mesentery and can also cause abdominal pain. The mesenteric cyst is located between the two layers of the mesentery. When the patient is active, the root of the mesentum may be pulled due to gravity or cause slight bowel in the intestine. Therefore, abdominal pain is a frequently occurring symptom. Mild abdominal pain can last from half an hour to several hours. In severe cases, it can be accompanied by fever, vomiting, and diarrhea. It lasts for several days and can relapse after remission.
3. Other performance
Because the mesenteric cyst is more free, the weight of the tumor is easy to cause intestinal torsion, and often causes acute intestinal obstruction. Huge cysts can cause chronic intestinal obstruction, and 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. Compression of the ureter can produce symptomatic or asymptomatic urinary tract obstruction.
Individual patients may develop ascites due to rupture of the cyst. Corrosion of the cyst or invasion of the intestinal wall can cause blood in the stool. Patients can also show loss of appetite, weight loss, fever, nausea, vomiting, diarrhea, constipation and so on.
The diagnosis of mesenteric cysts relies mainly on clinical manifestations and the above-mentioned auxiliary examinations.
Diagnosis
Differential diagnosis
Identification
Mesenteric tumors should be distinguished from ovarian cysts, pancreatic cysts, ascites, pedicled ureter fibroids, hydronephrosis, gallbladder effusion, peritoneal tongue tumors, migratory kidney and spleen cysts or tumors.
Small cysts are generally asymptomatic and signs. When the cyst is enlarged to a certain extent, a series of clinical signs and symptoms appear.
Abdominal mass and bloating
Abdominal bloating and touching the mass are the initial symptoms of the patient's performance and are the main findings in the physical examination. The mass is painless and tender. When the cyst is bleeding or infected, the mass may have tenderness. The boundaries are clear or unclear, depending on the disease, but there are no clear lumps. The capsule is sexy or rubber-like. If the tumor is too large, the abdomen has a sense of vibration. The degree of activity is usually large and regular: since the mesenteric root fixed to the posterior abdominal wall is fixed from the upper left to the lower right and longitudinally, the activity of the mesenteric root cyst is large in the lateral direction and moves along the upper right to the lower left axis. The upper and lower activities are limited; if the cyst is located around the mesentery, the upper and lower and left and right activities are large.
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
For intermittent abdominal pain, repeated attacks. It is caused by the compression or twist of the intestine; the larger cyst squeezes the mesentery, which increases the tension of the mesentery and can also cause abdominal pain. The mesenteric cyst is located between the two layers of the mesentery. When the patient is active, the root of the mesentum may be pulled due to gravity or cause slight bowel in the intestine. Therefore, abdominal pain is a frequently occurring symptom. Mild abdominal pain can last from half an hour to several hours. In severe cases, it can be accompanied by fever, vomiting, and diarrhea. It lasts for several days and can relapse after remission.
3. Other performance
Because the mesenteric cyst is more free, the weight of the tumor is easy to cause intestinal torsion, and often causes acute intestinal obstruction. Huge cysts can cause chronic intestinal obstruction, and 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. Compression of the ureter can produce symptomatic or asymptomatic urinary tract obstruction.
Individual patients may develop ascites due to rupture of the cyst. Corrosion of the cyst or invasion of the intestinal wall can cause blood in the stool. Patients can also show loss of appetite, weight loss, fever, nausea, vomiting, diarrhea, constipation and so on.
The diagnosis of mesenteric cysts relies mainly on clinical manifestations and the above-mentioned auxiliary examinations.
