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Aims A mesenteric cyst, rare intra-abdominal pathology, poses a clinical challenge due to lack of pathognomonic symptoms, variability in presentation and location. We present an interesting case with a significant diagnostic dilemma; a suspected benign ovarian cyst invading the mesentery on repeat imaging and laparoscopy is questioned for mesenteric in origin. Methods A 77-year-old female presented with a 6-year history of abdominal mass. She had multiple radiological scans which reported it as a simple cyst, but the origin could not be defined. She had repeated aspirations with benign cytology. They cyst developed septations, filled-up rapidly, became an abdominal cyst from the pelvis. A careful decision was taken for surgery. The procedure undertook with general surgeons and gynaecologists with a possibility of the mesenteric cyst. During laparotomy, the cyst was found extending from pelvis and base of mesentery up to the diaphragm densely adhered to sigmoid colon. The cyst was completely excised with hysterectomy and oophorectomy. Results The patient recovered well from surgery. Post-operatively, histopathology confirmed Figo IC2 Grade 2 mucinous adenocarcinoma of the ovary with an expansive growth pattern. She is awaiting further treatment with chemotherapy after discussion in the Gynaecology MDT. Conclusion This case emphasises the importance of having an insight into the question of established diagnosis in the face of a changing clinical picture. Also, it highlights the need for understanding the mesenteric cyst. Early exploration can prevent diagnostic delays and further treatment.

EP.TH.697The great mimic of mesenteric cyst - an interesting case report of mucinous adenocarcinoma of the ovary