Laparoscopic resection of a giant mesenteric cyst: a case report and literature review

Introduction: Mesenteric cysts are rare intra-abdominal lesions that can present with nonspecific symptoms or be discovered incidentally. Although typically benign, large cysts may produce significant compressive effects, necessitating surgical removal. Minimally invasive techniques, such as laparoscopy, have emerged as safe and effective approaches for their management. Case presentation: This report describes a case of a 43-year-old male patient who presented with progressive abdominal pain and distension over several months, accompanied by anorexia, nausea, intermittent vomiting, and constipation. Clinical examination revealed a distended abdomen with diffuse tenderness but no signs of peritonitis. Laboratory investigations were largely unremarkable except for mild normocytic anemia (hemoglobin 11.2 g/dl). Abdominal ultrasonography followed by contrast-enhanced computed tomography revealed a large, unilocular cystic lesion measuring 24 × 18 cm, arising from the small bowel mesentery and compressing adjacent bowel loops. The patient underwent laparoscopic resection of the cyst. Intraoperatively, the cyst was decompressed and completely excised using a harmonic scalpel, with careful preservation of the adjacent bowel and mesenteric vasculature. Histopathological analysis confirmed a benign mesenteric cyst. The postoperative course was uneventful, and the patient was discharged on postoperative day three. At 20-month follow-up, he remained asymptomatic with no evidence of recurrence. Discussion: Mesenteric cysts, while uncommon, should be considered in the differential diagnosis of chronic or progressive abdominal distension and discomfort. Their etiology remains unclear, and they may arise anywhere along the mesentery, with the small bowel mesentery being the most frequent site. Preoperative imaging is crucial for diagnosis and surgical planning. Although open surgery has traditionally been the mainstay, laparoscopic resection has become increasingly favored due to its advantages, including reduced postoperative pain, shorter hospital stays, and quicker return to normal activities. This case underscores that even giant cysts can be successfully managed laparoscopically with meticulous surgical technique, highlighting the expanding role of minimally invasive surgery in complex intra-abdominal pathologies. Conclusion: This case highlights the effectiveness and safety of laparoscopic management for giant mesenteric cysts. Even with large lesions causing significant mass effect, minimally invasive resection allows for complete excision, rapid recovery, and excellent long-term outcomes.