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2007-01-15-21 Answer to the case of the week #193 © Suseela

Answer to the case of the week #193 

May 17 - May 31, 2007 

Vavilala Suseela, MD.

Andhra Pradesh State, India


This is a 23-year-old-woman, primigravida, referred to our unit at 21-22 weeks. The first scan performed at 14-15 weeks was normal. The first scan performed at 14-15 weeks was normal. Her family history was unremarkable in terms of consanguinity and following ultrasound findings were discovered.

Figures 1, 2. 21-22 weeks: unilocular, mid-line, cystic lesion.


The cyst was below the stomach, and seen separate from the bladder. A provisional diagnosis of fetal abdominal cyst was made with the differential diagnosis of Ovarian, Mesenteric, Omental, or Duplication cysts. The parents were counseled and a prenatal karyotype with cyst aspiration was given. The possible complications of torsion and pressure effects on the surrounding organs were explained. The importance of follow up with serial scans was emphasized. The parents have refused to undergo any prenatal intervention, but however agreed for serial scans.

Figures 3, 4. 3D a 2D picture of cystic abdominal mass at 28th week of pregnancy. Cyst size: 6.12 cm x 3.85 cm; volume of the cyst 69.93 cm3;


Figures 5, 6, 7. Scan at 31-32 weeks, cyst size 6.12 cm x 3.85 cm; volume of the cyst 69.93 cm3; normal AFI: 15.0 cm; small bowel with normal pattern; kidneys were normal.



Figures 8, 9, 10. A repeat scan at 35th week of pregnancy; the intra abdominal cyst and polyhydramnios are visible; dilated bowel loops (figure 10) 


Delivery Details

The patient was admitted at 36 weeks of gestation with premature rupture of membranes and had a spontaneous vaginal delivery of 2190 g female baby with a good Apgar score.

Figures 11, 12. Postnatal ultrasonographic appearance of the cyst and radiogram.


Figures 13, 14. Postnatal appearance of the baby with prominent cyst at a level of upper abdomen.


Figures 15, 16. Perioperative appearance of the cyst. Laparotomy revealed mesenteric cyst with jejunal obstruction. Excision of the cyst, resection of the segment of the jejunum and end to end anastomosis were done.


Figure 17. The mesenteric cyst with a loop of jejunum.


Histopathological examination

Sections show wall of cyst lined by intestinal epithelium and presence of muscular layer. At the area of adherence segment of bowel and cyst wall share the muscular layer. There is no evidence of any atypia. Final diagnosis: mesenteric cyst.


Post operative period was uneventful; baby recovered and was discharge at 15th day of life. At the time of the report the baby was 13 months old and weighed 12 kg with normal growth and development.

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