A teenage boy presents with a painless abdominal swelling around the umbilical region. The swelling is cystic (fluctuant) and moves freely in the axis of the left iliac fossa to right hypochondrium.
What is the most likely diagnosis?
Decoding the Stem
Explanation
B. Mesenteric cyst: ✅ Correct. Mesenteric cysts are rare benign intra-abdominal lesions. Key clinical markers include a painless abdominal swelling, fluctuance (cystic nature), and free mobility in the transverse axis (perpendicular to the root of the mesentery).
A. Retroperitoneal tumour: ❌ These are typically fixed masses located deep in the abdomen and do not show free mobility across the axis.
C. Hydatid cyst: ❌ Usually liver-based or fixed in a specific organ; they do not classically demonstrate mobility from one iliac fossa to the opposite hypochondrium.
D. Lymphoma: ❌ These present as firm, solid, often lobulated masses, not as fluctuant cystic swellings.
E. Hydronephrosis: ❌ Originates from the kidney; it is a flank mass that is bimanually palpable and ballotable, typically midline umbilical.
🧠High-Yield Pearls
Integrated Clinical Questions
1. Most common location of mesenteric cyst?
2. Nature of fluid inside?
3. Best investigation?
4. Treatment?
5. What is the classic clinical sign for mesenteric cyst mobility?
⚡ Exam Pearls
- Fluctuant + freely mobile = mesenteric cyst.
- Moves perpendicularly to the line of attachment of the mesentery.
- Always differentiate from retroperitoneal masses (which are fixed).
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