BACKGROUND: Few studies have analyzed the cyst characteristics and complications of mesenteric lymphatic malformations (ML). This study aimed to compare ML\'s cyst characteristics and preoperative complications at different locations and suggest a modified ML classification for patients requiring surgery.
METHODS: In total, 157 ML patients underwent surgery at Beijing Children\'s Hospital between January 2010 and December 2021. The cyst characteristics and preoperative complications were reviewed. The surgical methods for ML were analyzed according to the modified ML classification (Type I, n = 87, involving the intestinal wall; Type II, n = 45, located in the mesenteric boundaries; Type III, n = 16, involving the root of the mesentery; Type IV, n = 7, multicentric ML; Type V, n = 2, involving the upper rectum).
RESULTS: Overall, 111 (70.7%) ML were located at the intestinal mesentery and 44 (28.0%) at the mesocolon. Type I and type II ML mainly involved intestinal mesentery (64.9%) and mesocolon (56.8%), respectively (P < 0.001). Microcystic-type ML and ML with chylous fluid were only located in the intestinal mesentery. Intestinal volvulus was only found in patients with ML in the intestinal mesentery (P < 0.001), whereas ML in the mesocolon were more prone to hemorrhage (P = 0.002) and infection (P = 0.005). ML in the jejunal mesentery was an independent risk factor for intestinal volvulus (OR = 3.5, 95% CI 1.5-8.3, P = 0.003). The surgical methods significantly differed between Type I and type II ML (P < 0.001).
CONCLUSIONS: ML at different locations have different characteristics. For patients requiring surgery, the new ML classification can be used to select an appropriate surgical method.
METHODS: Level III.

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Cystic lesions of the mesentery, omentum, and retroperitoneum are rare; from 1956 to 1990, 22 patients had operative treatment for such lesions at our institution. They ranged in age from 1 month to 14 years; 75% were younger than 5 years. All had either an acute abdomen or, more commonly, a silent abdominal mass. In all cases, the histologic diagnosis was lymphangioma. Abdominal ultrasonography was done in all cases after 1977 except for two patients who had an acute abdomen requiring emergency exploration. A cystic abdominal mass was diagnosed in 94% of these cases, but the correct diagnosis of lymphangioma was made prior to surgery in only 24%. Mesenteric cysts are most common in the small bowel mesentery. Omental cysts usually occur singly and are easily resected, but multiple cysts predominate in the mesentery and retroperitoneum. Complete resection was accomplished in 82% of our cases. Two patients required partial bowel resection, and four had partial excision with marsupialization of the cysts. With a mean follow-up of 23 months, we have had three recurrences, but none necessitated reexploration. Extra-abdominal lesions, mainly cutaneous lymphangiomas, developed in two cases. Prognosis is good after surgical excision, but long-term follow-up is advisable because of the possibility of recurrence, even during adulthood.

This study is based on a group of 34 primary tumours of the mesenterium which were treated in the first surgical Clinic between 1960 and 1981. In this series were 19 women and 15 men, and the age of the patients varied between 16 and 68 years, being in the average of 44 years. Ten cystic tumours were recorded, and 24 solid tumours. Nine of the tumours were benign and the remaining 25 were malignant. The cystic tumours, for the most of the benign type, were almost exclusively cystic lymphangiomas. One serous cyst was also recorded, as well as one hematic cyst, and one dermoid cyst that had underwent malignization. The solid tumours were all malignant, of the sarcomatous type,, and their starting point was the mesenteral connective-vascular structures. The clinical picture of the mesenteral tumours is polymorphous and non-characteristic. In the frame of paraclinical examinations the radiologic investigation holds an important place and this is especially true for selective arteriography of the upper mesenteric artery, which provides useful informations concerning the topography of the tumour in relation to the mesenteral vascular trunk. Therapeutic possibilities are discussed, and the fact is stressed that, for improving the prognosis an early diagnosis is essential.

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