A chylous mesenteric cyst is one of the rarest of abdominal tumor. Most investiators favor the opinion that chylangiomas arise from embryonic rests of the lymphatic tissue. The others believe that these cysts can arise by congenital or acquired abstruction of the lacteals. As in case of many other types of cysts, the chylous mesenteric cysts seldom cause notable symptoms until complications develop such as partial intestinal obstruction, torsion of the cyst, and rupture of the cyst. Recently authors experienced a case of multiple chylangiomas of the mesentery associated with the involvement of the small intestine.
A 21 year-old airman was admitted to the Aero-Medical-Center on June 13, 1966 because of abdominal pain and a palpabel lump on periumbilical region. There were several episodes of similar previous attacks for these 40 days. The pain was severe, intermittent and accompanied by nausea and vomiting.
Physical examination revealed a tender, walnut sized, movable mass over the right umbilical region. Laboratory studies and upper G-Ⅰ series were not unusual. Upon exploratory laparatomy, multiple, large and small cysts were found to occupy the mesentery of the distal jejunum and proximal ileum. Aspirations of the cysts revealed chyle and occasionally serous fluid. The cecum and the appendix was displaced to the right upper quadrant with thin and tense ascending mesocolon. The involved segment of the bowel measuring 100 cm. in length was resected with mesentery. The continuity was reestablished by closed end-to -end anastomosis. A cecopexy was done. The hospital course and follow up was uneventful.
Grossly, the cysts were mostly unilocular and measured up to 5 cm. in diameter, averating 1.0 cm. (Fig. 1). The interior aspects were smooth and glistening without notable inflammatory changes(Fig. 2 & 3).
Microscopically the cysts were lined by endothelium with outer hick fibrous wall in which smoe smooth muscles were intermingled(Fig. 6 & 7). Inflammatory reaction was not conspicuous throughout the lesions. Involved intestinal wall showed marked lymphangiectatic changes with lymphatic fluids in them. These findings were extended into the mesenteric lymphnodes where proper lymphoid elements were much effaced due to marked dilatation of the lymphatics and proliferative endothelial cells in areas(Fig. 8).
Authros also briefly discussed the etiology and pathogenesis, choice of management and pathological pictures of the cysts, along with the litrature review.
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