Original communication| Volume 5, ISSUE 4, P522-534, April 1939

Cysts of the omentum, mesentery, and retroperitoneum

A clinical study of eighteen cases
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      • 1.
        1. An analysis of 18 cases of cysts of the omentum, mesentery, and retroperitoneum operated upon from 1915 to 1938 is presented.
      • 2.
        2. Only those cysts which have no connections with any adult anatomic structure are included in this report. It is emphasized that omental, mesenteric, and retroperitoneal cysts all should he grouped as one, namely retroperitoneal, for embryologically and pathologically they have a similar origin.
      • 3.
        3. In this series there were 3 omental, 5 mesenteric, and 10 cysts arising from behind the posterior peritoneum; 7 patients were males and 11 were females. Although these cysts occur at any age, 10 of the 18 patients were under 30 years of age.
      • 4.
        4. Symptoms and signs can be divided into acute and chronic. The acute symptoms are often occasioned by hemorrhage into the cyst or rupture of the cyst wall. The chronic symptoms are usually mild, the main complaint being that of a progressively growing abdominal tumor. Principal symptoms and signs were (1) generalized, nonlocalizing, constant, abdominal pain; (2) palpable tumor mass; (3) abdominal tenderness. Albuminuria was noted in 9 cases.
      • 5.
        5. The exclusion, by x-ray examination, of the gastrointestinal and urinary tracts as the seat of the pathology is helpful in establishing the diagnosis of omental, mesenteric, or retroperitoneal cyst.
      • 6.
        6. Omental cysts are usually large, thin walled, multiloculated, and contain serosanguineous fluid. They tend to rupture easily, thus causing acute symptoms. Mesenteric cysts are often the size of a grapefruit, are thick walled, do not rupture easily but tend to cause intestinal obstruction. If they arise from the mesentery of the small bowel, they usually contain chylous fluid. Cysts arising from behind the posterior peritoneum grow to huge dimensions, are thin walled, occasionally rupture, and most often contain straw-colored or serosanguineous fluid.
      • 7.
        7. Little information concerning the origin of these cysts can be gained through microscopic examination. The commonest findings are either a cyst wall composed of loose fibrous tissue structure alone or a flat endothelial layer surrounded by a fibrous tissue layer.
      • 8.
        8. All 18 patients recovered following operation. Wherever possible, complete resection should be performed, but, if complete enucleation makes a hazardous procedure of the operation, then marsupialization or simple incision and drainage of the cyst is sufficient. These cysts show little tendency to recur or to undergo malignant degeneration. We did not find it necessary to do extensive surgery, for complications such as others have reported in the literature did not occur in our series of cases.
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