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The abdomen
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Appendicitis may produce an inflammatory mass in the right iliac fossa. In the acute phase, the overlying guarding may make it difficult to palpate the mass, at least until the patient is anaesthetised. The mass is tender, has ill-defined margins and is immobile. It should be distinguished from a large ovarian cyst, which tends to be non-tender and mobile, and can be manipulated in and out of the pelvis. However, if an ovarian cyst has undergone torsion, it too may be difficult to palpate on account of overlying guarding and other signs of peritonism. In a child under 3 years of age, the possibility of an intussusception mass must be considered. In these children, there will be colicky pain and vomiting. In the older child, a relatively painless immobile mass is more suggestive of a lymphoma; other supporting features may include weight loss, fever, lymphadenopathy and hepatospleno- megaly. Less common causes include Meckel diverticulitis, Yersinia lymphadenitis, duplication cyst, lymphangioma, omental cyst, mesenteric cyst, omental infarction, tuberculosis or actinomycosis. In children with cystic fibrosis, severe constipation or distal intestinal obstruction syndrome from inspissated luminal gut content or appendiceal pathology may produce a palpable abdominal mass.
The peritoneum, omentum, mesentery and retroperitoneal space
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Tumours situated in the mesentery give rise to physical signs that are similar to those of a mesenteric cyst, the sole exception being that they sometimes feel solid. If indicated, a benign tumour of the mesentery is excised in the same way as an enterogenous mesenteric cyst, i.e. with resection of the adjacent intestine. A malignant tumour of the mesentery requires biopsy confirmation and specific, usually nonsurgical, treatment, e.g. chemotherapy for lymphoma.
Gastrointestinal and hepatobiliary
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
The following mesenteric neoplasms are benign. True or false? Mesenteric lipodystrophy.Lipoma.Mesenteric cyst.Neurofibroma.Peritoneal mesothelioma.
Bowel obstruction following ingestion of superabsorbent polymers beads: literature review
Published in Clinical Toxicology, 2022
Weniko Caré, Laurène Dufayet, Nathalie Paret, Jacques Manel, Hervé Laborde-Casterot, Ingrid Blanc-Brisset, Jérôme Langrand, Dominique Vodovar
Abdominal radiography, with (N = 7) or without oral contrast (N = 36), was performed in 31/43 patients and showed air-fluid levels and/or bowel dilatation, but none showed evidence of foreign body ingestion [3,5,10,15–22,24–31,33,34] (Table 1). In one case, gastrointestinal perforation was suspected with the presence of free gas under the diaphragm [22]. Abdominal computed tomography scanning, with (N = 4) or without (N = 6) oral contrast, was performed in 10/43 patients [16–19,21,25,28,29,34,35] and visualized an intraluminal mass in 5/10 cases [16,18,21,25,34]. In two cases, cyst duplication was evoked [16,18]. Abdominal ultrasound, performed in 34/43 patients [3,5,14–18,22,25–27,29,31–34] and allowed visualization of a rounded intraluminal image that could correspond to a SAPs bead in 28/34 patients [3,5,14–18,25–27,31–33], but led to a correct diagnosis of foreign body-induced bowel obstruction in only 15/34 cases (including at least two cases in which ingestion of the object was known) [3,14,15,27,31]. Based on abdominal ultrasound, evoked diagnosis were pancreas pseudocyst, ovarian or mesenteric cyst, enteric duplication, neoplasm, or enterocystoma [15,16,26,31–33]. One case reported the contributory use of abdominal magnetic resonance imaging (MRI) [16]. Superabsorbent polymer-made beads were always located in the small bowel (from the duodenum to the terminal ileum) [3,5,10,14–35].
Chylous Ascites in an Infant with Thanatophoric Dysplasia Type I with FGFR3 Mutation Surviving Five Months
Published in Fetal and Pediatric Pathology, 2018
Jeon Soo-kyeong, Narae Lee, Mi Hye Bae, Young Mi Han, Kyung Hee Park, Shin Yun Byun
Only a few reports in the literature have described cases of patients who have survived beyond the neonatal period. Stensvold et al. (20) reported a 169 day survival, Tonoki (21) reported a 212 day survival, and Noe et al. reported 4 months survival (22). Of the patients who survive into adulthood, Nakai et al. (23) reported survival of 23 years and Nikkel et al. (24) reported survival of 26 years. All patients exhibited distinct developmental delay, severe growth deficiency, dependence on a ventilator, and skin disorders such as seborrheic keratoses and acanthosis nigricans. In our case, the patient showed accompanying chylous ascites, which was not previously reported. The patient’s condition improved following the switch to the MCT formula. Accordingly, CT, lymphangiography, or lymph node biopsies were not performed. The patient had no medical history of abdominal surgery, injury, infection, or liver cirrhosis, which are known causes of chylous ascites. There was a possibility that the patient had congenital abnormalities, such as lymphangiectasia, mesenteric cyst, or idiopathic leaky lymphatics, which are the most common causes of chylous ascites in pediatric patients. However, we could not ascertain this as the patient’s parents refused autopsy. It is difficult to determine if the chylous ascites was part of the TD deformity or just happened to accompany the TD.
An accidental finding of a giant intra-abdominal mass
Published in Acta Chirurgica Belgica, 2023
Jonathan Mertens, Ann Driessen, Niels Komen
To further differentiate the size and origin of the cystic lesion, computed tomography (CT) and magnetic resonance imaging (MRI) studies were performed. Both MRI and CT showed an enormous lobulated abdominal cyst, measuring 22.3 × 14.5 × 24.0 cm, centered in the mesentery of the left hemi-abdomen with an imbedded daughter cyst with a longitudinal diameter of 0.43 cm (Figures 1 and 2). As there was no connection with other organ structures, and the cyst seemed to originate from the mesentery of the jejunum, a mesenteric cyst was strongly suspected. Because of the absence of a relationship to the liver, the absence of pulmonary lesions, negative serologic tests for Echinococcus, the possibility of a diagnosis of a hydatid cyst was significantly reduced [15].