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A lower abdominal mass, particularly one on the left side, is more often related to
chronic functional constipation than to Hirschsprung disease. If a mass is found, a
careful review of bowel habits is important. If an abdominal mass is a fecaloma, a
large bolus of stool can usually be felt on rectal examination just inside the anus.
The evacuation of the impaction, and irrigation of the upper sigmoid colon,
should cause the mass to disappear. See Chapter 18 Constipation for the causes of
constipation.
Ovarian Masses
Simple ovarian cysts and solid teratomas are not uncommon and may be
asymptomatic even when large in size. Occasionally, the child presents with
urinary complaints from the pressure on the bladder or urethra. Granulosa cell
tumors of the ovary produce precocious puberty because they are hormonally
active tumors. They may be malignant. The sudden onset of severe abdominal
pain may indicate torsion of an ovarian mass, with resultant ovarian infarction.
Radiographs may show calcification in about half of patients with teratomas (
Fig. 116.22 ). Because an occasional ovarian tumor is malignant in children,
children with ovarian masses should be evaluated promptly and prepared for
surgery.
Omental Cysts
Omental cysts are rare, are usually asymptomatic, and can fill the abdomen. It is
often difficult to differentiate an omental cyst from ascites. Smaller cysts are
more mobile and can be pushed freely into all quadrants of the abdomen. If a cyst
volvulizes on its pedicle or has bleeding within it, it may cause abdominal pain or
tenderness. Elective surgical excision is indicated.
Mesenteric Cysts
Mesenteric cysts can occur anywhere in the mesentery but are most common in
the mesentery of the colon. They tend to be multilocular and are often discovered
during a routine examination or after an episode of abdominal trauma with
enlargement from bleeding. They are benign, but surgery is indicated, both to
confirm the diagnosis and to prevent complications. They can usually be removed
with sparing of the bowel, or they can be marsupialized into the general

peritoneal cavity where the fluid is absorbed.