Omental. or. mesentric cysts occur rarely and of them chylous or lymphatic cysts are the most common but pseudocysts are less common in incidence than true cysts.
The pseudocysts of omentum or mesentery are developed from inflammation, fat necrosis, parasites, foreign body reaction, or trauma with hemorrhage. Pancreatic pseudocysts most commonly follow pancreatitis, but they may develop after trauma, esspecially nonpenetrating blunt abdominal trauma. The surgical procedures for omental and mesenteric pseudocysts are somewhat different from that, of pancreatic pseudocysts in which internal drainage, -especially Roux-en-Y cystojejunostomy, has been most frequently used.
Omental or mesenteric pseudocysts can be totally removed without difficulty by local excision or enucleation with or without subsequent intestinal resection resulting in a good prognosis with minial morbidity and mortality.
A case of omental cyst and a case of mesenteric cyst which were successfully treated in Kwang-ju Christian Hospital are reported and compared with pancreatic pseudocysts developed from the same etiology.
Both cysts developed in children under the age of 10 years due to nonpenetrating blunt abdominal trauma.
The patient with the omental cys thad acute abdominal symptoms including severe abdominal pain, progressive abdominal distention and fever of short duration. However the other patient with mesenteric cyst had painless abdominal distention, anemia and malnutrition gradually
progressing over long period without acute abdominal symptoms.
On physical examination the abdominal distention in both patients was not easily differentiated from ascites.
The omental cyst was totally removed with ease by local excision from the greater omen-
tum. It was multilocular, 8xl5x2Ocni in size, smooth surfaced, thin-walled, and there was about 700ml of yellow serous fluid contained in the cyst.
The mesenteric cyst was monolocular, occupying almost the entire abdominal cavity from subphrenic region to the Cul-de-sac. There was extensive displacement and compression of the gastrointestinal tract and left ureter resulting in hydronephrosis. It contained about 6, 000 ml non-coagulable, old bloody fluid inside a thick wall, about 10 mm at the thickest part. It wass
almost totally enucleated without subsequent intestinal resection by careful decortication witbout injury to the mesentric vasculature, alimentary tract or left ureter. A very small portion. of the cyst wall was not removed because it engulfed the ureter.
Both cysts were confirmed as being pseudocysts by histopathology.
By this experience it is suggested that the incidence of intraabdominal pseudocysts, including retroperitonial cysts such as pancreatic pseudocysts, are increased after nonpenetrating blunt abdominal trauma. Huge cysts should be first differentiated from ascites. And if local excision, enucleation with subsequent intestinal resection, or drainage procedures are not indicated decortication has been demonstrated to be a satisfactory method of treatment.
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