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UNUSUAL CASE |
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| Year : 2012 | Volume
: 8
| Issue : 2 | Page : 57-58 |
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Laparoscopic excision of a giant mesothelial omental cyst
Aparna A Deshpande1, Abhay N Dalvi2
1 Department of Surgery, BSES MG Global Hospital, Andheri, Mumbai, Maharashtra, India
2 Department of Surgery, Jupiter Hospital, Thane, Maharashtra, India
| Date of Submission | 04-Mar-2011 |
| Date of Acceptance | 23-Mar-2011 |
| Date of Web Publication | 2-May-2012 |
Correspondence Address:
Aparna A Deshpande
8, Chaitraban, Hanuman Cross Rd 1, Vile-Parle (E), Mumbai - 400 057
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-9941.95538
A 42-year-old patient presented with right-sided abdominal discomfort. Investigations revealed a 19 × 21 centimetres large cystic lesion occupying nearly the entire right side of the abdomen. It was situated between ascending colon and right kidney and extended from the liver to the pelvic inlet supero-inferiorly. Laparoscopic excision was planned. The cyst was aspirated completely and dissected from the surrounding structures. It was eventually found to be arising from the right free edge of the greater omentum. Due to its size and weight it was lodged behind the ascending colon. Post-operative course was uneventful. Histology revealed a mesothelial omental cyst. Omental cysts are rare abdominal tumours. Complete excision is the treatment advised to prevent recurrence. Laparoscopic excision can be safely performed taking care to ascertain diagnosis and not to damage any structures intra-operatively.
Keywords: Omental cyst, laparoscopy, excision
How to cite this article:
Deshpande AA, Dalvi AN. Laparoscopic excision of a giant mesothelial omental cyst. J Min Access Surg 2012;8:57-8 |
| ¤ Introduction | |  |
Mesothelial cysts of the greater omentum are extremely uncommon. [1] Giant omental cysts are more often reported in children and are frequently misdiagnosed as ascites. [2] We report laparoscopic excision of a giant omental cyst in an adult patient.
| ¤ Case Report | | |
A 42-year-old female patient presented with complaints of right-sided abdominal discomfort and constipation for 6-8 months. Ultrasonography revealed a cystic lesion occupying the right side of the abdomen. A contrast enhanced computed tomography (CT) scan revealed a 21 × 19 cm unilocular cystic lesion situated between the right kidney and the ascending colon [Figure 1], extending from the liver superiorly to the pelvic inlet inferiorly [Figure 2]. Rest of the organs were normal. Serum immune haemagglutination (IHA) for echinococcus was negative. Patient was subjected to laparoscopy. Four ports, two with the diameter of 10 and other two with the diameter of 5 mm were used. The ascending colon was splayed over the cyst. Aspiration of the cyst drained 4 l of serous fluid. [Figure 3] The cyst wall was dissected from the surrounding structures and was eventually seen to be arising from the right edge of the omentum. The cyst was completely removed. Postoperative course was uneventful and patient was discharged on day 2. Histology revealed a fibrous wall lined by mesothelial cells. Patient is asymptomatic at 2 years follow up. | Figure 1: Contrast enhanced computed tomography showing a large cyst between the right kidney and ascending colon.
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| ¤ Discussion | | |
Omental cysts are rare abdominal cystic lesions. The presentation may vary from asymptomatic or vague complaints as in our case [3] to acute abdominal conditions due to complications like torsion. [4]
Good imaging is necessary to have a roadmap for surgery. [3] A CT scan will show the details of location and relation to other structures, as in our case. Though the cyst was omental, because of its sheer size and weight, it had lodged into the space behind the colon. Thin walled, unilocular omental cysts are lymphangiomas [3] and rarely mesothelial.cysts. Complete excision is necessary in both to prevent recurrence.
Laparoscopic excision of omental cysts has been infrequently reported. [5] Laparoscopic approach is feasible even in very large cysts as in our case. In our patient despite the size of the cyst, it was possible to achieve pneumoperitoneum without compromising the cardiovascular physiology. Once the cyst was completely aspirated, there is adequate space for dissection. Laparoscopy is of great benefit in these patients to prevent large incisions without compromising surgical principles and helps in early recovery.
| ¤ References | | |
| 1. | Ignjatovic M, Cerovic S, Cuk V. Mesothelial cyst and cystic mesothelioma of the greater omentum. Case report and literature review. Acta Chir Iugosl 2001;48:77-83. 
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| 2. | Shafi SM, Malla MA, Reshi FA. Giant primary omental cyst mimicking pseudoscites. Afr J Pediatr Surg 2009;6:58-60.
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| 3. | Uramatsu M, Saida Y, Nagao J, Takase M, Sai K, Okumura C, et al. Omental cyst: Report of a case. Surg Today 2001;31:1104-6.
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| 4. | Fitoz S, Atasoy C, Ekim M, Yildiz S, Erden A, Aktug G. Torsion of a giant omental cyst mimicking ascites. J Clin Ultrasound 2007;35:85-7.
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| 5. | Conzo G, Vacca R, Grazia Esposito M, Brancaccio U, Celsi S, Livrea A. Laparoscopic treatment of an omental cyst: A case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2005;15:33-5.
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[Figure 1], [Figure 2], [Figure 3]
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