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Key Points

  1. Most abdominal cysts are asymptomatic and are discovered by prenatal imaging.

  2. Diagnosis is made by a combination of ultrasound, CT scans, and MRI.

  3. Large size (>5 cm), pain, and signs of intestinal obstruction are the most common indications for intervention.

  4. Treatment is aimed at complete excision of the cyst. When not possible, percutaneous drainage with sclerosis or marsupialization is a reasonable alternative.

  5. Overall prognosis is excellent except in the rare case of malignant lesions.

Pediatric surgeons are often consulted to evaluate infants and children with cystic lesions of the abdomen. With nearly all pregnant women receiving prenatal ultrasound, requests for evaluation of fetal cystic lesions have also become more commonplace. A variety of cystic lesions have been described in the newborn infant, with most of them now diagnosed with great accuracy in the fetus (Table 52-1). A rather different set of cystic masses is found in the older infant and child, although a large overlap occurs (Table 52-2). While the true nature of a cystic mass can often only be determined at operation, the age of the patient, and the size, location, and mobility of the lesion are important findings that can aid in determining its nature and risk. Imaging studies can further refine the diagnosis, and can sometimes assist in providing temporary, or even definitive, therapy.

Table 52-1Diagnosis by Location of Cysts in the Fetus and Infant
Table 52-2Diagnosis by Location of Cysts in the Older Child

The finding of an abdominal cystic lesion in the newborn is rarely an indication for emergency surgery. The exception is the occasional very large mass that causes respiratory embarrassment. Even in this circumstance, temporary ventilation, sometimes accompanied by needle aspiration or percutaneous drainage, will allow time for an adequate preoperative evaluation. Intestinal obstruction is also an occasional presenting symptom that requires more rapid therapy. Palpation of the abdomen, paying particular attention to the mobility of the cyst, may provide a clue to a cyst's etiology. Cysts of the omentum, mesentery, some duplication cysts, and all but the largest ovarian cysts (the attached fallopian tube stretches to allow movement) are often easily manually movable around the abdomen. Rectal exam and pelvic exam in the older child are helpful ...

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