Abstracts
1998 Digestive Disease Week

#1060

RETROPERITONEAL AND MESENTERIC CYST: CHARACTERISTICS AND SURGICAL MANAGEMENT. B.K. Poulose, M.F. Kutka, M.A. Talamini, K.D. Lillemoe, and J.L. Cameron, The Johns Hopkins University School of Medicine. Baltimore, Maryland.

Retroperitoneal (RC) and mesenteric cysts (MC) are rare clinical entities, with only 300 cases reported in the English literature. Historically, their presentation includes nonspecific abdominal symptoms, and management strategies have included marsupialization, partial excision and drainage, or complete resection. Despite being of common origin, it is unclear whether these abdominal tumors have similar presentations and if similar surgical management is appropriate. To gain further experience with these tumors, we performed a retrospective study of the cases of RC and MC presenting to a tertiary care center for the past 49 years, representing the largest study to date of these lesions at a single institution. Patients with a diagnosis of RC or MC were identified from surgical and pathological records from 1949-1997. Thirty-one patients with cysts of congenital or neoplastic origin were entered into the review, including 14 cases of RC and 17 cases of MC. Cysts of traumatic or infectious etiology were excluded. Clinical, radiological, operative, and pathological factors were examined with total mean follow up of 65 months. Both RC and MC patients tended to be white (75%) females (75%) with mean ages of 40 (RC) and 31 (MC) years. The most common complaint for RC and MC was abdominal pain (29% and 65%, respectively). Twenty-nine percent of RC patients and 21% of MC patients were asymptomatic. The correct preoperative diagnosis was achieved in 8% of the RC group and 30% of the MC group. Diagnostic modalities for both groups included CT (53%), ultrasound (20%), MRI (13%), IVP (8%), and small bowel series (8%). Complete excision was performed on 71% of RC patients with no recurrence, while partially resected RC tumors recurred in 50% of cases. Patients undergoing partial excision had a significantly higher rate of major complications. Organs adherent to RC tumors included: pancreas, spleen, adrenal, kidney, IVC, aorta, and esophagus. All MC patients underwent complete cyst excision with no recurrence and no major complications, although 18% required bowel resection. RC and MC present similarly and are often asymptomatic. Despite current radiologic techniques, preoperative identification of these tumors can be difficult, and definitive diagnosis is usually made at the time of surgery. Complete resection is the procedure of choice for both RC and MC, even if bowel resection is required.

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