2-Year Abdominal Pain Due to Rare Mesenteric Cyst Successfully Treated in 11-Year-Old

Eleven-year-old Mohit was brought to Sarvodaya Hospital, Sector 8, Faridabad with worsening pain in the right lower part of his abdomen and repeated episodes of vomiting. While the recent pain had become sharp and severe, limiting his appetite and daily activities, the story had actually begun much earlier.

For nearly two years, Mohit had been experiencing intermittent right lower abdominal pain with a dragging sensation. The discomfort was vague at first and would settle temporarily, making it easy to overlook. However, over the past one and a half months of the diagnosis, the intensity increased significantly. The pain became frequent enough to interfere with school and normal play, prompting urgent medical evaluation.

A Rare Diagnosis Behind Common Symptoms - Mesenteric Cysts

Right-sided abdominal pain in children most commonly suggests appendicitis. However, an earlier ultrasound performed elsewhere had detected a 5 × 6 cm cyst in the mesentery (the tissue that anchors the small intestine and carries its blood vessels).

At Sarvodaya Hospital, Mohit underwent detailed clinical evaluation followed by a contrast-enhanced CT (CECT) scan of the abdomen. This imaging was essential to accurately define:

• The exact size and location of the cyst
• Its relationship with intestinal loops
• Proximity to major blood vessels
• Presence of additional cysts or complications
  
  

Why Was the Surgery Necessary?

Although benign, mesenteric cysts can lead to serious complications if left untreated, including Intestinal obstruction (volvulus), Infection or rupture, Hemorrhage into the cyst and more.
Given Mohit’s worsening symptoms and the size of the lesion, complete surgical excision was advised.

Laparoscopic Surgery and Swift Recovery

The paediatric surgical team, led by Dr Shweta K Sharma, Consultant, Paediatric Surgery, performed laparoscopic excision using fine 3–5 mm instruments. Through small keyhole incisions, the cyst was carefully dissected and removed while preserving the surrounding intestine and its delicate blood supply.

He was kept under observation for a day and was discharged within two days of surgery with nutritional guidance. He has now returned to school and can perform daily activities without residual symptoms. The surgical scars were so benign that they were barely visible.

Benefits of Minimally Invasive (Laparoscopic) Surgery

• Smaller incisions: Tiny cuts result in minimal scarring.
• Less pain: Reduced tissue damage leads to lower postoperative discomfort.
• Faster recovery: Early mobilisation, often within 24 hours.
• Shorter hospital stay: Many patients are discharged within 1–3 days.
• Lower infection risk: Smaller wounds reduce complication rates.
• Minimal blood loss: Enhanced precision and magnified visualization.
• Quicker return to routine: Children resume school and activities sooner.

What Is Mesentery?

The mesentery is a thin, fold-like structure inside the abdomen that attaches the small intestine to the back wall of the abdomen. In simple terms, the mesentery acts as a support system and lifeline for the small intestine.

Its key functions include:

• Holding the intestines in place
• Carrying blood vessels that supply oxygen and nutrients
• Carrying lymphatic vessels and immune cells
• Supporting nerves that help bowel function
  
  

What Is a Mesenteric Cyst?

A mesenteric cyst is a fluid-filled sac that develops within the mesentery. These cysts are rare and occur in approximately 1 in 2,00,000 children. Most mesenteric cysts are congenital, meaning they are present from birth. However, they may remain small and symptom-free for years.

As they grow, they can cause:

• Abdominal pain
• Vomiting
• Swelling in the abdomen
• Symptoms similar to appendicitis

These cysts can present in different ways:

• Some are detected antenatally during fetal scans
• Some remain completely asymptomatic
• Older children may present with vague abdominal pain, nausea, vomiting, distension, constipation due to pressure effect (mass effect), or an incidental finding on ultrasound
• In some cases, a palpable abdominal lump may be felt

Role of Antenatal Scans During Pregnancy

Modern antenatal ultrasound and fetal scans can detect many congenital abdominal abnormalities, including mesenteric cysts. Early detection helps in:

• Planning delivery at a centre with paediatric surgical support
• Counselling parents in advance
• Avoiding emergency situations later in life
  
  

Role of a Paediatric Surgeon in this Case

Children are not small adults; their anatomy and physiology are different. Surgical decisions must be precise to avoid damage to delicate structures.

A paediatric surgeon plays a critical role in:

• Differentiating mesenteric cyst from appendicitis and other abdominal emergencies
• Interpreting imaging carefully to assess blood vessel involvement
• Planning minimally invasive surgery
• Preserving maximum intestine and blood supply
• Ensuring faster recovery with minimal scarring
  
  

Key Takeaway for Parents

Persistent abdominal pain, especially on the right side, should not be ignored, even if it seems like appendicitis. Rare conditions like mesenteric cysts can present similarly.

With accurate diagnosis, expert paediatric surgical care, and minimally invasive techniques, these rare conditions can be treated safely with excellent outcomes.