History and Physical Examination

Pain is the principal presenting symptom resulting in the discovery of a mesenteric mass. A palpable mass may also be present, though generally not without some abdominal pain. Nausea, vomiting, diarrhea, bloating, and constipation have also been described with mesenteric tumors.

Although most symptoms reflect a fairly indolent process, intestinal obstruction has been reported with benign and malignant mesenteric tumors. In the case of malignant tumors, this is generally secondary to aggressive local growth. In the case of benign tumors such as lipoma, the pathophysiology of obstruction is more complex.

Published descriptions of obstruction with mesenteric lipoma have implicated small-bowel encasement, small-bowel volvulus, or tumor infarction and obstruction due to the consequent inflammatory mass. Acute appendicitis as the result of torsion of a mesoappendiceal lipoma has also been described.

Clinical examination may reveal an abdominal mass. In the case of mesenteric lipoma, the tumor frequently cannot be appreciated by palpation. In the case of mesenteric cysts, physical examination findings may reveal a mass lesion that is mobile only from the patient's right to left or left to right (Tillaux sign), in contrast to the findings with omental cysts, which should be freely mobile in all directions.

Workup

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Media Gallery

Massive mesenteric cyst that proved to be multiloculated lymphangioma. This large but benign structure had developed on narrow attachment to base of small-bowel mesentery and was amenable to excision without endangering any other mesenteric structures.
Cluster of enlarged lymph nodes (arrows) in small-bowel mesentery, which on laparoscopic biopsy proved to be B-cell (follicular) lymphoma.
Mesenteric lymph node mass with metastatic involvement of small-bowel carcinoid. This was resected en bloc along with segment of small bowel within arterial blood supply distribution affected by removal of mass. This small intestine contained subcentimeter primary carcinoid tumor.
Axial contrast-enhanced MRI of central hyperintense fatty mesenteric mass with preservation of fat around vessels and lymph nodes with "fat ring" or “halo” sign (arrows) consistent with mesenteritis. Courtesy of BioMed Central Ltd, Springer Nature [Arda K, Kizilkanat KT, Aydin H. CT and MRI aspect of mesenteric panniculitis. J Case Rep Med 7. 2018 Jun 30.]
CT image of increased mesenteric tissue density or “misty mesentery” (between arrows), which laparoscopic incisional biopsy demonstrated was sclerosing mesenteritis.
CT image of benign mesenteric lipoma. This discrete lesion (arrows) is homogeneous and has density of normal surrounding mesenteric fat.
Laparoscopic view of simple mesenteric cyst before laparoscopic excision.
Laparoscopic view of simple mesenteric cyst dissection bed after laparoscopic excision.
Mesenteric GIST-like tumor with solid and cystic components. Diagnosis was established after resection with demonstration of absence of primary GI tumor.
Resected mesenteric tumor. Operative treatment involved segmental small-bowel and colon resection. Large specimen size is evident.
Section of malignant mesenteric fatty tumor resected en bloc with obstructed, encased small intestine.

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Mesenteric Tumors Clinical Presentation

History and Physical Examination

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