Mesenteric Cyst Infected With: Salmonella Typhimurium
Mesenteric Cyst Infected With: Salmonella Typhimurium
Mesenteric Cyst Infected With: Salmonella Typhimurium
1. Khoo A. Acute cholestatic hepatitis induced by Epstein-Barr virus 6. Cauldwell K, Williams R. Unusual presentation of Epstein-Barr
infection in an adult: a case report. J Med Case Rep. 2016;10:75. virus hepatitis treated successfully with valganciclovir. J Med
2. Kofteridis D, Koulentaki M, Valachis A, Christofaki M, Mazokopakis Virol. 2014;86:484---6.
E, Papazoglou G, et al. Epstein-Barr virus hepatitis. Eur J Intern 7. Rafailidis P, Mavros MN, Kapaskelis A, Falagas ME. Antiviral treat-
Med. 2011;22:73---6. ment for severe EBV infections in apparently immunocompetent
3. Vine L, Shepherd K, Hunter JG, Madden R, Thornton C, Ellis patients. J Clin Virol. 2010;49:151---7.
V, et al. Characteristics of Epstein-Barr virus hepatitis among
patients with jaundice or acute hepatitis. Aliment Pharmacol Anna Puy Guillén ∗ , Hernán Andreu Serra
Ther. 2012;36:16---21.
4. Shaw N, Evans J. Liver failure and Epstein-Barr virus infection. Servicio de Aparato Digestivo, Hospital Universitario Son
Arch Dis Child. 1988;63:432---45. Llàtzer, Palma de Mallorca, Balearic Islands, Spain
5. Devereaux CE, Bemiller T, Brann O. Ascites and severe hep-
atitis complicating Epstein-Barr infection. Am J Gastroenterol.
∗
Corresponding author.
1999;94:236---40. E-mail address: anna.puyguillen@gmail.com
(A. Puy Guillén).
Mesenteric cyst infected with abdominal computed tomography (CT) scan, revealing a cys-
tic mass measuring 7.7 cm × 10.3 cm × 3 cm in the right flank
Salmonella typhimurium夽 suggestive of a benign mesenteric tumour (Fig. 1B).
The patient was discharged without incident, then read-
Quiste mesentérico infectado por Salmonella mitted after 15 days with abdominal pain and persistent
typhimurium fever. A repeat CT scan showed the known mass with
complications (Fig. 1C). Percutaneous drainage was per-
Mesenteric cysts are uncommon intra-abdominal lesions. formed and a sample of fluid was taken for culture. In
They account for approximately one out of every 100,000 the microbiological results, enteric Salmonella, subspecies
hospital admissions in adults and one out of every 20,000 I, serogroup B, was isolated. The patient did not have
hospital admissions in children, with nearly 60% of cases diarrhoea, nor did he remember any recent prior episodes
developing before the age of five.1 thereof. His only notable comment was that he had taken
They may be located in any part of the mesentery, from a trip to Morocco a month earlier. Given these findings, a
the duodenum to the rectum, but they are most commonly stool culture was ordered and came back positive for the
located in the mesentery of the small bowel, in particular same type of bacteria. The strains were serotyped; both
the ileum.2 There is no clear evidence as to their aetiol- were found to belong to the Typhimurium serotype. Follow-
ogy; hence, they have been attributed to various causes ing clinical improvement and ultrasound, the patient was
(congenital, neoplastic, acquired or idiopathic). The most discharged.
recent classification is based on their origin depending on One month later, an elective procedure consisting of
histological and immunohistochemical findings: lymphatic, laparoscopic removal of the mesenteric cyst was performed.
mesothelial, urogenital, enteric, dermoid or pseudocystic.3 A decrease in size and a significant pericystic inflamma-
There are three main forms of clinical presentation. The tory reaction were observed. On the second day, the patient
asymptomatic form is the most common and is incidentally underwent further surgery for suspected bowel perforation,
diagnosed in complementary tests and surgical procedures. wherein purulent peritonitis and perforation of the trans-
The indolent form predominates in adults; the most com- verse colon were detected. Profuse lavage of the abdominal
mon symptoms are abdominal pain (80%), distension and an cavity plus primary wound closure were performed laparo-
abdominal mass (30%---50%). The complicated form (rupture, scopically. The patient subsequently followed a favourable
infection, obstruction, etc.)1 predominates in children. clinical course. Salmonella was not isolated in the cultures
We report the case of a 19-year-old patient with no obtained from the resected cyst or in a second stool culture.
history of note who visited the emergency department The pathology study showed a cystic formation made up
with abdominal pain for the past three days that followed of multiple concentric layers, with perforated, abscessed
a course consistent with acute appendicitis. Emergency panmural inflammation (Fig. 1D). The immunohistochem-
surgery was indicated, yielding the incidental finding of istry study was positive for smooth muscle actin and desmin
a large mesenteric cyst (Fig. 1A). Laparoscopic appendec- and confirmed a concentric muscle layer, with no traces
tomy was performed; the pathology results indicated that of epithelial or mesothelial lining observed. These findings
the caecal appendix had no histological abnormalities. In were suggestive of an intestinal duplication cyst.
the postoperative period, the study was completed with an Mesenteric cysts are rare and of varying aetiology.
Regardless of their presentation, surgery is the treatment of
choice in order to avoid malignant transformation and pre-
vent complications. Cyst aspiration as a sole treatment is not
夽 Please cite this article as: Nogués A, Aldea MJ, Cros B, Talal
recommended due to high associated rates of recurrence.3
I, Yánez C, Blas JL. Quiste mesentérico infectado por Salmonella
typhimurium. Gastroenterol Hepatol. 2022;45:135---136.
135
SCIENTIFIC LETTER
Figure 1 (A) Incidental finding of a mesenteric cyst during laparoscopic surgery for suspected acute appendicitis. (B) Cystic
tumour measuring 7.7 cm × 10.3 cm × 3 cm of apparent mesenteric origin in the right flank. (C) Known cystic mass, with increased
wall thickness, suggestive of a complicated cystic lymphangioma. (D) Histology slice viewed under a microscope of the concentric
cyst wall with inflammatory infiltrate.
Infection of a mesenteric cyst is a rare complication with 2. Cucho Janetliz, Ormeño Alexis, Valdivieso Falcon Lidia, Pereyra
few cases reported in the medical literature. The mecha- Sonia, Ramos Rodríguez, Karen. Quiste mesentérico en el Insti-
nism is usually unknown and may correspond to lymphatic, tuto Nacional de Salud del Niño, Lima, Perú: reporte de caso.
haematogenous or contiguous spread.4 Rev. gastroenterol. Perú. 2013;33:341---4.
With the exception of Salmonella typhi, which is respon- 3. Roberto Sosa Hernández, Carlos A, Sánchez Portela, Lorenzo
Simón, Rodríguez. Quiste del mesenterio: reporte de un caso y
sible for typhoid fever and whose only reservoir is humans,
revisión de la literatura. Rev Cubana Cir. 2007;46.
non-typhoidal Salmonella serotypes are found in the intesti- 4. Pérez Sánchez J, Pineda Solas V, Loverdos Eseverri I, Vilà de Muga
nal flora of various animal species and are transmitted to M. Linfangioma abdominal infectado por Salmonella enteritidis
humans through contaminated food. Gastroenteritis is the [Abdominal lymphangioma infected by Salmonella enteritidis].
main clinical sign; extraintestinal infections are rare.5 An Pediatr (Barc). 2005;63:264---6.
In conclusion, we have reported a rare case of a 5. Rodríguez, Carlos Hernán, de Mier, Carmen, Bogdanowicz, Eliz-
mesenteric cyst infected with Salmonella typhimurium; we abeth, Caffer, María Inés, Garcia, Susana, Lasala, María Beatriz,
suspected contiguous spread, given its enteric origin, but Vay, Carlos, Famiglietti, Angela. Salmonelosis extraintestinal:
were unable to rule out lymphatic and haematogenous clínica, epidemiología y resistencia antimicrobiana. Acta Bio-
spread from gastroenteritis. We wish to highlight the impor- química Clínica Latinoamericana 2007, 41; 379---383.
tance of proper diagnosis and treatment of this disease,
Ana Nogués a,∗,1 , Ma José Aldea b,1 , Beatriz Cros a,1 ,
given its rarity.
Issa Talal a,1 , Carlos Yánez a,1 , Juan Luis Blas a,1
a
Acknowledgements Servicio de Cirugía General y del Ap. Digestivo, Hospital
Royo Villanova, Zaragoza, Spain
b
The authors would like to thank Alicia Blasco and Sandra Servicio de Microbiología, Hospital Royo Villanova,
Vicente (Radiology Department and Pathology Department, Zaragoza, Spain
respectively, Hospital Royo Villanova [Royo Villanova Hos- ∗
Corresponding author.
pital]) for their help in selecting images. They would also
E-mail address: ananope@gmail.com (A. Nogués).
like to thank Dr Pilar Egido (Microbiology Department, Hos- 1
Hospital Royo Villanova, Av. de San Gregorio, s/n, 50015
pital Miguel Servet [Miguel Servet Hospital]) for her help
Zaragoza, Spain.
with serotyping the microbiological samples.
2444-3824/ © 2020 Elsevier España, S.L.U. All rights reserved.
References
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