CASE REPORT Mesenteric cysts associated with recurrent small-bowel volvulus: cause or effect? Shailesh M. Prabhu • Rama Anand • Mahender K. Narula • Gurucharan S. Shetty • Alok K. Udiya • Udit Chauhan • Shailaja Shukla • Jitendra Kumar Grover Received: 23 April 2012 / Accepted: 26 August 2012 / Published online: 19 September 2012 Ó Japan Radiological Society 2012 Abstract Recurrent small-bowel volvulus is a state of recurrent intermittent or long-standing persistent twisting of small-bowel loops around its mesentery. The association of mesenteric cysts with recurrent small-bowel volvulus as the cause or effect is a much debated issue in the literature. We report two cases of mesenteric lymphangioma and one case of enteric duplication cyst seen in association with recurrent small-bowel volvulus of long duration in absence of malrotation. Keywords Mesenteric cysts Á Recurrent small-bowel volvulus Á Mesenteric lymphangioma Á Enteric duplication cyst Á Cause Á Effect Introduction Cystic lesions of the mesentery are relatively uncommon in children. The majority of cases with mesenteric cysts presents with abdominal pain and gradually progressive abdominal distension [1]. Occasionally patients may pres- ent with repeated episodes of abdominal pain and vomiting due to recurrent small-bowel volvulus [2]. Three cases of cystic mesenteric lesions (two cases of mesenteric lym- phangioma and one of enteric duplication cyst) in combi- nation with recurrent small-bowel volvulus of long duration are presented below. Case report Case 1 A 2-year-old male child presented with a year-long history of intermittent episodes of abdominal pain and vomiting. Abdominal ultrasound (US) showed a 5 9 4-cm multi- locular anechoic cyst (arrow in Fig. 1a) in the right lower quadrant. The cyst was seen extending across the midline with whirling of superior mesenteric artery and vein around each other (Fig. 1b), which suggested a diagnosis of mes- enteric lymphangioma with small-bowel volvulus. On computed tomography (CT) a hypodense multilocular cyst (arrow in Fig. 1c) was noted in the intraperitoneal location with few enhancing septae, displacing the bowel loops laterally. There was twisting of mesenteric vessels and jejunal loops around the axis of the superior mesenteric artery suggesting the whirlpool sign (arrow in Fig. 1d). At laparotomy, 360° anticlockwise twisting of jejunal loops around its mesentery was seen and the duodenojejunal and ileocacal junctions were normal in position. The cyst was S. M. Prabhu (&) Á R. Anand Á M. K. Narula Á A. K. Udiya Á U. Chauhan Department of Radiodiagnosis, Lady Hardinge Medical College and Assoc. SSK and KSC Hospitals, Connaught Place, New Delhi 110001, India e-mail: shailesh182@gmail.com G. S. Shetty Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India S. Shukla Department of Pathology, Lady Hardinge Medical College and Assoc. SSK and KSC Hospitals, Connaught place, New Delhi 110001, India J. K. Grover Department of Pediatric Surgery, Lady Hardinge Medical College and Assoc. Kalawati Saran Childrens Hospital, Connaught Place, New Delhi 110001, India 123 Jpn J Radiol (2012) 30:858–862 DOI 10.1007/s11604-012-0131-2