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Tawashi K, Alabdullah H, Alokla AH, Alkalet AB. Mesentery lymphangioma led to the acute abdomen, a case report with a rare location and unexpected diagnosis. Int J Surg Case Rep 2024; 119:109730. [PMID: 38703615 PMCID: PMC11087714 DOI: 10.1016/j.ijscr.2024.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Lymphangioma is a benign tumor, containing thin-walled lymphatic spaces. The most affected sites are head, neck, axilla, and parenchymal organs. Mesentery lymphangioma is a rare case; it happens in <1 % of cases. PRESENTATION OF CASE A 25-year-old man came to the hospital, complaining of acute abdominal pain. The pain started in the morning and developed progressively. The physical examination was not helpful. The abdominal X-ray in the erect position was within normal. The ultrasound imaging findings were limited; they showed only a cystic mass in the pelvis. So, the investigatory laparotomy was indicated. During the laparotomy, we found a sizeable mass originating from the small bowel mesentery and pressed on it. The mass is located at a distance of 50 cm from the treitz ligament. We excised the mass and related intestinal loops. The histopathological examination showed that it was a cystic lymphangioma. DISCUSSION Lymphangioma is a benign tumor that forms when early lymphatic spaces fail to connect to the lymphatic system. The diagnosis of the lesion depends on radiological investigations because the manifestations and the laboratory investigations are not specific, but histopathology examination is still the only method to determine diagnosis. The treatment of lymphangioma depends on radical surgery. CONCLUSION Mesenteric lymphangioma is a rare condition with unspecific symptoms and radiological and laboratory findings, so we should keep it in mind when the patient comes with general abdominal manifestations and we cannot put a determined diagnosis. Laparotomy should be done rapidly in such cases to avoid life-threatening complications.
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Jha T, Sharma M, Ahuja A. Mesenteric cystic lymphangioma in adults: a rare entity presenting as acute abdomen - a report of two cases. Autops Case Rep 2024; 14:e2024470. [PMID: 38476732 PMCID: PMC10927243 DOI: 10.4322/acr.2024.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/08/2024] [Indexed: 03/14/2024]
Abstract
Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.
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Affiliation(s)
- Tanvi Jha
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Department of Pathology, New Dehli, India
| | - Monika Sharma
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Department of Pathology, New Dehli, India
| | - Arvind Ahuja
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Department of Pathology, New Dehli, India
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3
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Rajendran S, Hui TCH, Lin NS. Torsed mesenteric lymphangioma causing closed-loop small bowel obstruction in an adult patient. ANZ J Surg 2023; 93:779-781. [PMID: 36086886 DOI: 10.1111/ans.18034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
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Wang L, Feng H, Chen B, Luan F. Case Report: Endoscopic manifestations and clinical features of small intestinal lymphangioma-A report of two cases. Front Oncol 2022; 12:916295. [PMID: 36568194 PMCID: PMC9773366 DOI: 10.3389/fonc.2022.916295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The aims of this study were to analyze the clinical characteristics, auxiliary examinations, and treatment measures of small intestinal lymphangioma and to improve the clinical diagnostic ability of clinicians. Methods This paper reports two cases of small intestinal lymphangioma in the Department of Gastroenterology, the First Affiliated Hospital of Soochow University, and makes a comprehensive analysis. Results A 31-year-old woman went to the hospital with complaints of dizziness, fatigue, and anemia. A 52-year-old woman complained of upper abdominal pain and went to the hospital with abdominal pain awaiting investigation. Both patients were subjected to three major routine examinations, tumor complete set, CT, capsule endoscopy, and deep enteroscopy, and both of them underwent complete resection of the affected intestinal segment. Pathology showed that both patients had small intestinal lymphangioma. Conclusions The clinical manifestations of small intestinal lymphangioma lack specificity. Capsule endoscopy and deep enteroscopy are helpful for clinical diagnosis, and pathological examination is still the gold standard. Surgical treatment can achieve better results.
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Thapa S, Sharma A, Upreti D, Karki OB, Regmi S, Ghartimagar D, Ghosh A. A Huge Mesenteric Lymphangioma Presenting as a Small Bowel Volvulus in a Paediatric Patient: A Case Report. Case Rep Pathol 2022; 2022:3033705. [PMID: 35620582 PMCID: PMC9130006 DOI: 10.1155/2022/3033705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
Lymphangioma is a benign tumor characterized by proliferation of thin-walled lymphatic spaces. Lymphangioma of the small-bowel mesentery is rare, with an incidence of 1 : 250,000, representing less than 1% of all lymphangiomas. The predilection of the tumor is in the head and neck (70%), axillary (20%), and internal organs (10%). They are usually asymptomatic but can cause acute abdominal symptoms due to complications such as volvulus, bleeding, or lymphangioma rupture that require emergent surgery. Here, we report a case of mesenteric lymphangioma (ML) of a small bowel in a paediatric patient who presented with pain abdomen on and off which increased in severity and later had features of subacute intestinal obstruction. He underwent explorative laparotomy, and the mass was excised completely along with the part of small intestine. Pathological analysis of the surgical specimen confirmed the diagnosis of ML of the small intestine. The postoperative recovery was uneventful, and the patient was discharged after ten days of hospital stay. Though benign in nature, ML may cause acute abdominal symptoms that require emergent surgery. Therefore, it has to be kept in differential diagnosis of the acute abdominal condition.
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Affiliation(s)
- Sushma Thapa
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Abhinav Sharma
- Department of Surgery, Adesh Medical College and Hospital, Ambala, Haryana, India
| | - Dipesh Upreti
- Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Om Bahadur Karki
- Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Sudeep Regmi
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Dilasma Ghartimagar
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Arnab Ghosh
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
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6
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Heidtmann F, Eckoldt F, Mentzel HJ, Alhussami I. Primary Segmental Small Bowel Volvulus in an Adolescent Female. European J Pediatr Surg Rep 2021; 9:e76-e79. [PMID: 34849329 PMCID: PMC8612868 DOI: 10.1055/s-0041-1735808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/05/2021] [Indexed: 11/07/2022] Open
Abstract
Small bowel volvulus is a rare but important cause of abdominal pain and small bowel obstruction in children and adults. In the neonate, small bowel volvulus is a well-known complication of malrotation. Segmental small bowel volvulus is a lesser-known condition, which occurs in children and adults alike and can rapidly progress to bowel ischemia. Primary segmental small bowel volvulus occurs in the absence of rotational anomalies or other intraabdominal lesions and is rare in Europe and North America. Clinical presentation can be misleading, causing a delay in diagnosis and treatment, in which case the resection of necrotic bowel may become necessary. We report on a 14-year-old girl who presented with severe colicky abdominal pain but showed no other signs of peritoneal irritation or bowel obstruction. An emergency magnetic resonance imaging was highly suspicious for small bowel volvulus. Emergency laparotomy revealed a 115 cm segment of strangulated distal ileum with no underlying pathology. We performed a detorsion of the affected bowel segment. Despite the initial markedly ischemic appearance of the affected bowel segment, the patient achieved full recovery without resection of bowel becoming necessary.
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Affiliation(s)
- Friederike Heidtmann
- Department of Pediatric Surgery, Universitätsklinikum Jena, Klinik für Kinderchirurgie, Universitätsklinikum Jena, Jena, Germany
| | - Felicitas Eckoldt
- Department of Pediatric Surgery, Universitätsklinikum Jena, Klinik für Kinderchirurgie, Universitätsklinikum Jena, Jena, Germany
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology I, Universitätsklinikum Jena, Jena, Thüringen, Germany
| | - Ilmi Alhussami
- Department of Pediatric Surgery, Universitätsklinikum Jena, Klinik für Kinderchirurgie, Universitätsklinikum Jena, Jena, Germany
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7
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Alhasan AS, Daqqaq TS. Extensive abdominal lymphangiomatosis involving the small bowel mesentery: A case report. World J Clin Cases 2021; 9:9990-9996. [PMID: 34877341 PMCID: PMC8610896 DOI: 10.12998/wjcc.v9.i32.9990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/16/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal lymphangiomatosis is a rare benign condition accounting for less than 1% of all the cases of lymphangiomatosis. Management usually involves radical surgical excision; however, depending upon the extent of involvement, patient condition, and absence of complications, conservative management can be also considered.
CASE SUMMARY We present the case of a 32-year-old male who presented with short onset abdominal pain and melena. Physical examination findings were within normal limits, except for left lower abdominal tenderness. Upper gastrointestinal endoscopy was within normal limits. Abdominal and pelvic ultrasound and computed tomography (CT) scan revealed numerous, variably-sized cystic lesions within the abdominal cavity, exclusively and extensively affecting the small bowel mesentery with sparing of the retroperitoneum. The diagnosis was confirmed by CT and cytological examination. Radical surgical excision was technically impossible in this patient because of the extensive involvement of the mesentery; therefore, the patient was managed conservatively.
CONCLUSION Extensive and exclusive small bowel mesentery involvement in abdominal lymphangiomatosis is rare. Imaging modalities play an important role in establishing the diagnosis and conservative management can be considered when surgery is technically impossible.
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Affiliation(s)
- Ayman S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine Taibah University, Madinah 42353, Saudi Arabia
| | - Tareef S Daqqaq
- Department of Radiology and Medical Imaging, College of Medicine Taibah University, Madinah 42353, Saudi Arabia
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Barghash M, Nassif S, Alkurdi Y, Mansour M. Mesenteric Lymphangioma Presenting With Small Bowel Volvulus in an Adult. Cureus 2021; 13:e16771. [PMID: 34513383 PMCID: PMC8405412 DOI: 10.7759/cureus.16771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/25/2022] Open
Abstract
Benign tumours of vascular and lymphatic origin are known as lymphangiomas. In this report, we present a case of a 26-year-old lady admitted with symptoms of small bowel obstruction. Her computed tomography (CT) scan showed a well-defined mass in the small bowel mesentery associated with small bowel volvulus. Segmental resection of the bowel, including the mass, was performed. Microscopic examination and immunohistochemistry of the specimen were consistent with lymphangioma of the small bowel mesentery.
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Affiliation(s)
| | - Suad Nassif
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | - Yazan Alkurdi
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | - Moustafa Mansour
- General Surgery, North Manchester General Hospital, Manchester, GBR
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Creger PE, Harper C, Curry C, Kramer A. Resection of an Asymptomatic Lymphangioma in a 76-Year-Old Male. Cureus 2021; 13:e15577. [PMID: 34277199 PMCID: PMC8270067 DOI: 10.7759/cureus.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/10/2021] [Indexed: 11/05/2022] Open
Abstract
Lymphangiomas are benign congenital malformation comprised of the lymphatic system. They typically present in the head, neck, and axillary regions of children with <1% being described in the small bowel mesentery. We report a case of a 76-year-old man who presented with incidental large (9x6 cm) multiloculated cystic mass in the right upper quadrant (RUQ) on a CT scan performed for nephrolithiasis. He was asymptomatic at the presentation. We performed a diagnostic laparoscopy which was converted to an open procedure due to the mesenteric mass extending deeply toward the mesenteric root. The depth of invasion required small bowel resection with primary side-to-side anastomosis. Pathology confirmed a lymphangioma of the small bowel mesentery with histopathological analysis and cytology negative for malignant cells. Lymphangiomas are benign masses, however, their complete resection, including the resection of the involved organs is necessary. Incomplete resection or drainage is no longer used in management due to high rates of recurrence. Mesenteric lymphangiomas, while typically benign congenital malformations, can progress and impact surrounding structures via mass effect. Definitive treatment of lymphangiomas, even when asymptomatic, should be complete resection.
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Affiliation(s)
- Paul E Creger
- Department of General Surgery, Kansas City University, Kansas City, USA
| | - Charles Harper
- Department of General Surgery, St. Mary's Medical Center, Blue Springs, USA
| | - Chelsea Curry
- Surgical Pathology, Centerpoint Medical Center, Independence, USA
| | - Adam Kramer
- Department of General Surgery, St. Mary's Medical Center, Blue Springs, USA
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10
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Prasad SN, Singh RKR, Chaturvedi P, Singh V. Mesenteric Lymphatic Malformation Causing Midgut Volvulus in an Adult: An Unusual Presentation. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1727581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractMesentery is an uncommon location for occurrence of lymphatic malformations. Lymphatic malformations causing midgut volvulus are described in pediatric population; however, it is a rare presentation in adults. We present case of 20-year-old man with a large mesenteric lymphatic malformation who presented with acute abdominal complaints. On radiological work up, the lymphatic malformation was seen causing midgut volvulus and closed loop small bowel obstruction with the presence of classical whirlpool sign. The patient underwent emergency surgery and the lymphatic malformation was completely excised along with resection of a segment of small bowel loop.
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Affiliation(s)
- Surya Nandan Prasad
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rani Kunti R. Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pragya Chaturvedi
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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11
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Abdulraheem AK, Al Sharie AH, Al Shalakhti MH, Alayoub SY, Al-Domaidat HM, El-Qawasmeh AE. Mesenteric cystic lymphangioma: A case report. Int J Surg Case Rep 2021; 80:105659. [PMID: 33636409 PMCID: PMC7918257 DOI: 10.1016/j.ijscr.2021.105659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Mesenteric cystic lymphangiomas are rare benign lesions characterized by lymphatic vessels malformation with an unknown etiology. Although, mesenteric cystic lymphangiomas are rare but should be included in the differential diagnosis of abdominal pain. Surgical resection of mesenteric lymphangiomas should be performed as fast as possible to avoid many serios complications.
Introduction and importance Mesenteric cystic lymphangiomas are rare benign lesions of the abdominal cavity characterized by lymphatic vessels malformation with an unknown etiology. Despite the silent clinical course of mesenteric cystic lymphangiomas, they are considered as clinically tricky lesions with an immense spectrum of presentations. Case presentation We present a case of abdominal mesenteric cystic lymphangioma in a 1-year 9-month-old female patient, who complained of fever and abdominal pain for 10 days duration. Laboratory investigations, abdominal X-ray, ultrasonography, computed tomography and histopathological examination were all used to establish the diagnosis. Clinical discussion A trial of true-cut biopsies performed by an interventional radiologist was not informative, so a multidisciplinary team decision was made to excise the mass. Intraoperative findings include multiloculated fused cystic lesion (8.0 × 5.0 × 4.0 cm) on the descending mesocolon. Histopathological examination revealed the diagnosis of a mesenteric cystic lymphangioma. The postoperative period was not complicated. Conclusion Mesenteric cystic lymphangiomas are mostly asymptomatic in nature, yet predisposed to life threating events. Surgical excision is the modality of treatment characterized by low recurrence rate and a non-complicated postoperative period.
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Affiliation(s)
- Ahmad K Abdulraheem
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan.
| | - Ahmed H Al Sharie
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Majd H Al Shalakhti
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Saleh Y Alayoub
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan.
| | - Hamzeh M Al-Domaidat
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
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Raufaste Tistet M, Ernst O, Lanchou M, Vermersch M, Lebert P. Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas. Abdom Radiol (NY) 2020; 45:3589-3607. [PMID: 32296900 DOI: 10.1007/s00261-020-02525-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs). RESULTS ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery. CONCLUSION Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses.
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Affiliation(s)
- M Raufaste Tistet
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France.
| | - O Ernst
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - M Lanchou
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - M Vermersch
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - P Lebert
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
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13
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Kitamura H, Yamamoto D, Kadoya S, Bando H, Okayama Y, Minato H. Jejunal mesenteric lymphangioma treated by pancreaticoduodenectomy: A case report. Int J Surg Case Rep 2020; 77:165-169. [PMID: 33161289 PMCID: PMC7653000 DOI: 10.1016/j.ijscr.2020.10.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Small bowel mesenteric lymphangiomas in adults are rare. A huge lymphangioma infiltrated the pancreas and duodenum. A pancreaticoduodenectomy was required to remove it completely.
Introduction A lymphangioma is a benign congenital malformation of the lymphatic system that generally appears in the head, neck, and axillary regions. Small bowel mesenteric lymphangiomas have been described in less than 1% of lymphangiomas. Presentation of case We report the case of a 20-year-old woman who presented with abdominal pain. Computed tomography revealed a large (22 cm in diameter) multi-cystic lesion inferior to the processus uncinatus of the pancreas. As the presumptive diagnosis was a lymphangioma of the jejunal mesentery, we decided to perform a laparotomy. Intraoperatively, the peritoneal cavity was found to be fully occupied by a multi-cystic lesion that arose from the root of the jejunal mesentery and the processus uncinatus of the pancreas. It was adherent to the duodenum and inseparable from the duodenum and the processus uncinatus. A subtotal stomach-preserving pancreaticoduodenectomy was performed. The tumor was diagnosed as a lymphangioma of the jejunal mesentery after histopathological analysis. Discussion Although lymphangioma is benign, complete resection, including resection of the involved organs, is necessary. Incomplete resection has a 10% postoperative recurrence rate and may also be associated with complications. To the best of our knowledge, this is the first reported case of a mesenteric lymphangioma treated by pancreaticoduodenectomy. Conclusion Although the lymphangioma was pathologically benign, a pancreaticoduodenectomy was required to remove it completely. When a tumor’s location and size cause impingement on surrounding structures, surgeons should consider performing a pancreaticoduodenectomy to treat similar cases.
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Affiliation(s)
- Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Daisuke Yamamoto
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Yurie Okayama
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
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14
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Mohammed AA, Musa DH. Lymphangioma of the ileum causing acute abdominal pain in an adult, a very rare finding during surgery; Case report with literature review. Int J Surg Case Rep 2020; 66:319-321. [PMID: 31901559 PMCID: PMC6940693 DOI: 10.1016/j.ijscr.2019.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 11/21/2022] Open
Abstract
Lymphangioma of the gastrointestinal tract is very rare, 75 % of the lesions affect the neck and 20 % affect the axillary region. The majority of cases are asymptomatic but some cases presented with emergency presentations. Complete surgical resection is the main form of therapy whenever possible.
Introduction Lymphangioma of the gastrointestinal tract is very rare, 75 % of the lesions affect the neck and 20 % affect the axillary region, the rest are seen in the mediastinum, the visceral organs, the retroperitoneum, the mesentery, or in the bones. Lymphangioma of the gastrointestinal tract comprises less than 1 %. The majority of cases are asymptomatic but some cases presented with emergency presentations. Case presentation A 31-year-old male presented to emergency department complaining of central abdominal pain for 2 days, with nausea, dyspnea but no vomiting. The abdominal examination revealed a mildly distended abdomen, with guarding and tenderness mainly in the right lower abdominal quadrant. There were no any palpable masses or organ enlargement. The white blood cells count was elevated (14,000 c/mm). Abdominal ultrasound showed an evidence of 10*7 cm multiloculated thick walled lesion in the right lower abdomen, suggesting the possibility of an appendicular abscess. The patient was admitted for 2 days with little clinical improvement. Therefore, a laparotomy was performed at which there were 2 yellowish cystic lesions 60 cm from the ileocecal valve that were arising from each side of the small bowel and related to its mesentery causing luminal narrowing. Resection was done with end-end anastomosis. The histopathology results revealed a diagnosis of ill lymphangioma of the ileum. Conclusion Complete surgical resection is the main form of therapy whenever possible, sometimes is impossible when there is local invasion. When complete resection is performed long term follow up is not recommended as the recurrence is very rare.
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Affiliation(s)
- Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
| | - Dildar Haji Musa
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
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15
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Lymphangioma of the Small Intestine Case Report and Review of the Literature. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2018-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Lymphangioma usually occurs in children and usually involves the skin. Mesenteric lymphangiomas are extremely rare in adults (1,2,3). Lymphangioma of the small-bowel mesentery is rare, representing less than 1% of all lymphangiomas (4).
We report a case of a 62-year-old female who presented with abdominal pain, discomfort, nausea and vomiting. Pre-operative tests including abdominal ultrasonography and magnetic resonance imaging were performed, but they could not accurately determine the nature of the tumour. Laparotomy was performed; the tumour was excised completely, and a large cystic tumour of the small bowel mesentery was found. Histopathological examination diagnosed the tumour as a cystic lymphangioma. Lymphangiomas are extremely rare, especially in the abdomen of adults, and are asymptomatic for the most part; they often present as acute abdominal conditions, causing life-threatening complications such as secondary infection, rupture with haemorrhage, and volvulus or intestinal obstruction when the tumour increases in size, requiring emergent surgery. Lymphangioma is often difficult to diagnose, and surgical resection is selected in many cases for both diagnosis and treatment.
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A rare case of retroperitoneal and mesenteric lymphangiomatosis. Radiol Case Rep 2019; 15:11-14. [PMID: 31762861 PMCID: PMC6849486 DOI: 10.1016/j.radcr.2019.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022] Open
Abstract
Lymphagiomatosis are rare benign malformations of the lymphatic system. They are more commonly seen during childhood and are frequently asymptomatic and incidentally found in the adult patient. We report a case of a 31-year-old male who presented initially with melena. Computer tomography scan revealed multiple confluent, fluid-density lesions encasing the retroperitoneum and mesentery. A laparotomy and incisional biopsy of the mesenteric lesion was performed. Histologic examination demonstrated fibrofatty tissue with prominent, thick-walled endothelial-lined vessels. The histologic and computer tomography findings were consistent with a diagnosis of retroperitoneal and mesenteric lymphangiomatosis. The patient was subsequently discharged home well.
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Nagano H, Kimura T, Iida A, Togawa T, Goi T, Sato Y. Cystic lymphangioma in the peripheral jejunal mesentery in an adult and excision with laparoscopic-assisted surgery: a case report. World J Surg Oncol 2019; 17:170. [PMID: 31651341 PMCID: PMC6814111 DOI: 10.1186/s12957-019-1713-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background Lymphangiomas are uncommon congenital malformations that present mainly in the head, neck, and axillar regions in pediatric patients. Mesenteric cystic lymphangiomas (MCLs), which occasionally present with substantial growth and the invasion of adjacent vital structures, are rarely reported in adults. We report a case of MCL in an adult who was treated with laparoscopic-assisted excision. Case presentation A 40-year-old Japanese man visited his family physician for prolonged periumbilical pain. Plain computed tomography (CT) showed a low-density mass in his left abdomen, and he was referred to our hospital 2 weeks later. His abdomen was flat and soft, and no mass was felt upon palpation. Routine laboratory data showed no abnormalities in the blood cell counts. The levels of tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125), were within normal ranges. Contrast-enhanced CT was performed, and a low-density mass was observed with an irregular outline and poor contrast, as well as involvement of the peripheral mesenteric artery and partial compression of the adjacent jejunum without dilatation of the oral side of the bowel. The patient was diagnosed with lymphatic cysts and observed for 1 month without symptom exacerbation. Follow-up CT showed no increase in the size of the mass but showed apparent invasion of the jejunal wall without bowel obstruction. Magnetic resonance imaging (MRI) showed intermediate intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). The coronal view on T2WI clearly showed an accumulation of cystic lesions. We performed tumor excision with partial resection of the jejunum in a laparoscopic-assisted manner. Pathological examination showed multicystic lesions with an attenuated endothelial lining, surrounding rich adipose tissue and scattered smooth muscle fibers; the patient was diagnosed with MCL. Immunohistochemical assays supported this diagnosis. Conclusions This is rare case of MCL presenting in an adult who underwent successful laparoscopic-assisted resection. Mesenteric lymphangioma (ML) should be considered in the differential diagnosis of patients with intraabdominal cysts. Radical excision is optimal, even when the patient is asymptomatic. Laparoscopic-assisted tumor resection is a suitable surgical method for treating MLs located in the peripheral mesentery.
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Affiliation(s)
- Hideki Nagano
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan.
| | - Toshihisa Kimura
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Atsushi Iida
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Tamotsu Togawa
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yasunori Sato
- Department of Human Pathology Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
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Primary Intestinal Lymphangiectasia Causing Intussusception and Small Bowel Obstruction. ACG Case Rep J 2019; 6:e00233. [PMID: 31832461 PMCID: PMC6855551 DOI: 10.14309/crj.0000000000000233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
Abstract
Abdominal lymphangiectasia is a rare disease manifestation with a variety of anatomic locations and clinical presentations. The gastrointestinal tract may be affected, and lymphangiectasia originating in the wall of the intestine has rarely been described. We present a case of primary small bowel lymphangiectasia causing intussusception in a 30-year-old woman who presented with emesis and gastrointestinal bleeding. This case emphasizes the clinical presentation, diagnosis, and management in adults with abdominal lymphangiectasia. We highlight the importance of a high clinical suspicion for lymphangiectasia in an adult with acute abdomen to avoid catastrophic morbidity.
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Lim DR, Kuk JC, Kim T, Shin EJ. Surgery of multiple lymphangioma in small bowel: a rare case report of chronic gastrointestinal bleeding. Ann Surg Treat Res 2017; 94:52-56. [PMID: 29333427 PMCID: PMC5765279 DOI: 10.4174/astr.2018.94.1.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/15/2017] [Accepted: 04/01/2017] [Indexed: 02/06/2023] Open
Abstract
Small bowel lymphangioma is a rare benign tumor of the lymphatic system, characterized by the presence of dilated lymphatic spaces and significant gastrointestinal bleeding. Small bowel lymphangiomas are rare in adults and case reports are few. Lymphangiomas in the jejunum or ileum are extremely rare and account for less than 1% of all lymphangiomas. The case reported herein is of an older patient (70-year-old male) with melena and chronic anemia (hemoglobin count < 5 g/dL) who had small-sized multiple lymphangiomas in his small bowel (jejunum). Surgical resection was performed after failure of treatment by gastroenteroscopy. Final pathological analysis revealed lymphangioma with thrombus and hemorrhage. After surgery, he no longer had decreased hemoglobin count, nor symptoms of anemia and melena. Also, at the last follow-up visit, the patient's hemoglobin count patient was normal and he returned to normal daily functions.
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Affiliation(s)
- Dae Ro Lim
- Section of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jung Cheol Kuk
- Section of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Taehyung Kim
- Section of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Eung Jin Shin
- Section of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Abstract
Mesenteric cystic lymphangioma (MCL) is an uncommon, benign, slow-growing abdominal tumor that is derived from the lymphatic vessels (World J Gastroenterol. 2012;18:6328-6332, Radiographics. 1994;14:729-737). It is most often diagnosed in the head and neck of affected children. Rarely, a lymphangioma can develop within the small bowel (Pan Afr Med J. 2012;12:7). The clinical presentation of patients with an abdominal MCL can range from asymptomatic to acute abdominal pain (J Korean Surg Soc. 2012;83:102-106). We report a case of small bowel volvulus caused by an MCL in a 3-year-old child who presented to the pediatric emergency department with right lower quadrant pain. The child was thought to have a perforated appendicitis and was taken to the operating room where an MCL was identified and resected. This case illustrates the need to consider MCL when a patient presents to the emergency department with right lower quadrant pain.
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Case Report: Multivisceral Transplantation for an Extensive Cystic Lymphangioma of the Mesenteric Root. Transplant Proc 2016; 48:543-5. [PMID: 27109997 DOI: 10.1016/j.transproceed.2015.12.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 12/29/2015] [Accepted: 12/29/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND We report the case of a 7-year-old girl with intestinal failure owing to a cystic lymphangioma compromising the root of the mesentery, not amenable to resection, leading to intestinal failure. Oncologic treatment was attempted to reduce tumor size with no response; therefore, she was listed for multivisceral transplantation. PROCEDURE Resection of the tumor required resection of all abdominal organs with vascular inflow and outflow. A multivisceral graft (liver, stomach, duodenum-pancreas and spleen complex, small bowel, and right colon) was implanted. For vascular reconstruction, donor's superior vena cava was sutured to the recipient's suprahepatic veins in a common patch. For arterial inflow, an arterial conduit was placed directly to the infrarenal aorta, and sutured to an aortic patch of the graft. Cold ischemia time was 8:45 hours; warm ischemia time was 35 minutes. A double-layer gastrogastric anastomosis and piloroplasty was made; and the distal reconstruction was performed with ileocolic side-to-end anastomosis that allowed to perform of a Bishop-Koop ileostomy for endoscopic monitoring. OUTCOME The patient recovered well after the procedure and was discharged 36 days after transplantation with intestinal sufficiency. To the best of our knowledge, this is the first report describing cystic lymphangioma as an indication for multivisceral transplantation.
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Complete resection of a complicated huge mesenteric lymphangioma guided by mesenteric computed tomography angiography with three-dimensional reconstruction: report of a case. Int Surg 2016; 100:574-8. [PMID: 25785347 DOI: 10.9738/intsurg-d-14-00112.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We herein describe the case of an adult with a complicated huge lymphangioma of the small bowel mesentery. Computed tomography (CT) confirmed a 45 × 30 × 14 cm multiple and separate, mixed and solid cystic tumor without enhancement by contrast medium in the abdominal cavity. Mesenteric CT angiography with three-dimensional (3D) reconstruction showed that the tumor did not involve the first jejunal artery, although the tumor did involve the subsequent jejunal and ileal arteries and the corresponding segment of the small bowel. Under anatomic guidance based on mesenteric CT angiography with 3D reconstruction, we were able to successfully excise the tumor. Mesenteric lymphangioma should be excised even when the tumor is asymptomatic. Mesenteric CT angiography with 3D reconstruction is useful for the surgical treatment of huge mesenteric tumors.
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Patil AR, Nandikoor S, De Marco J, Bhat R, Shivakumar S, Mallrajapatna G. Disorders of the lymphatic system of the abdomen. Clin Radiol 2016; 71:941-952. [PMID: 27450410 DOI: 10.1016/j.crad.2016.06.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 12/31/2022]
Abstract
The lymphatic system of the abdomen comprises of the cisterna chyli, its major and minor lymphatic tributaries, and lymph nodes. Disorders of the lymphatic system of the abdomen are rarely encountered and consist of primary and secondary types. Abdominal lymphangiomas constitute the majority and have characteristic imaging features. Complicated lymphangiomas may pose a diagnostic dilemma. Generalised systemic lymphangiomatosis is a rare condition and affects major organs with a poor prognosis. Retroperitoneal lymphangiectasia in the appropriate setting might predict underlying infection, such as filariasis. Other acquired conditions include iatrogenic or treatment-induced chylocoele. Chylous ascites can be secondary to multiple causes and can be confirmed by biochemical testing and lymphangiogram in appropriate settings.
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Affiliation(s)
- A R Patil
- Departments of Radiology, Apollo Hospitals, Bannerghatta Road, Bangalore, India.
| | - S Nandikoor
- Departments of Radiology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
| | - J De Marco
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - R Bhat
- Surgical Gastroenterology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
| | - S Shivakumar
- Pathology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
| | - G Mallrajapatna
- Departments of Radiology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
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Romeo V, Maurea S, Mainenti PP, Camera L, Aprea G, Cozzolino I, Salvatore M. Correlative imaging of cystic lymphangiomas: ultrasound, CT and MRI comparison. Acta Radiol Open 2015; 4:2047981614564911. [PMID: 26019889 PMCID: PMC4437906 DOI: 10.1177/2047981614564911] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/23/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cystic lymphangioma is a rare benign lesion derived from the detachment of the lymph sacs from venous drainage systems; the treatment of choice is a surgical excision and the final diagnosis is of histological type. PURPOSE To compare the results of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in patients with cystic lymphangioma to clearly evaluate the anatomic as well as the structural lesion features necessary for differential diagnosis and for the patient treatment planning. MATERIAL AND METHODS We analyzed the imaging results of six patients admitted in our department to evaluate cyst-like tumor masses clinically palpable or detected by US. All the patients underwent US, CT, and MRI. The pathology reports demonstrated a mesenterial cystic lymphangioma in five cases underwent surgical resection and in the last case a chest cystic lymphangioma underwent a fine needle aspiration biopsy (FNAB). RESULTS In all the cases, the results of US, CT, and MRI were concordant showing cyst-like tumor masses in the abdomen (n = 5) and chest (n = 1) ranging in size from 3.5 to 15 cm. CONCLUSION According to our experience, we suggest that the appropriate diagnostic imaging protocol in patients with cystic lymphangioma should initially include the US study and followed by a MRI scan with contrast administration. CT should be avoided because of radiation exposure. US and MRI may also be useful in the follow-up of patients who refuse surgical resection or in whom surgery is contraindicated or postponed as well as to early detect a possible disease relapse.
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Affiliation(s)
- Valeria Romeo
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Naples, Italy
| | - Simone Maurea
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Naples, Italy
| | - Pier Paolo Mainenti
- Istituto di Biostrutture e Bioimmagini - Consiglio Nazionale delle Ricerche (IBB-CNR), Naples, Italy
| | - Luigi Camera
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Naples, Italy
| | - Giovanni Aprea
- Dipartimento di Chirurgia Generale, Geriatrica, Oncologica e Videoassistita, Università degli Studi di Napoli Federico II (UNINA); Fondazione SDN (IRCCS), Naples, Italy
| | - Immacolata Cozzolino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Naples, Italy
| | - Marco Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Naples, Italy
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Maqueda Merino A, Sardón Ramos JD, Vitores Lopez JM, Angulo Revilla I, Gastón Moreno A. [Mesenteric polycystic lymphangioma. A rare cause of acute surgical abdomen]. An Pediatr (Barc) 2014; 81:59-61. [PMID: 24439486 DOI: 10.1016/j.anpedi.2013.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/23/2013] [Indexed: 02/07/2023] Open
Affiliation(s)
- A Maqueda Merino
- Servicio de Cirugía General, Hospital Universitario de Álava-Txagorritxu, Vitoria-Gasteiz, Álava, España.
| | - J D Sardón Ramos
- Servicio de Cirugía General, Hospital Universitario de Álava-Txagorritxu, Vitoria-Gasteiz, Álava, España; Unidad Docente de Medicina de Vitoria, Universidad del País Vasco (UPV/EHU), Vitoria-Gasteiz, Álava, España
| | - J M Vitores Lopez
- Servicio de Cirugía General, Hospital Universitario de Álava-Txagorritxu, Vitoria-Gasteiz, Álava, España
| | - I Angulo Revilla
- Servicio de Cirugía General, Hospital Universitario de Álava-Txagorritxu, Vitoria-Gasteiz, Álava, España
| | - A Gastón Moreno
- Servicio de Cirugía General, Hospital Universitario de Álava-Txagorritxu, Vitoria-Gasteiz, Álava, España
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Rezvanizadeh A, S.Sadaghiani M, Mehdizadeh M, Alizadeh H. Midgut volvulus caused by mesenteric lipoma. IRANIAN JOURNAL OF PEDIATRICS 2013; 23:121-3. [PMID: 23549936 PMCID: PMC3575006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 12/16/2011] [Indexed: 11/23/2022]
Affiliation(s)
- Alireza Rezvanizadeh
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical sciences, Tehran, Iran
| | - Mohammad S.Sadaghiani
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical sciences, Tehran, Iran,Corresponding Author:Address: Department of Radiology, Imam Khomeini Hospital, KeshavRZ Blvd, Tehran, Iran. E-mail:
| | - Mehrzad Mehdizadeh
- Radiology Division, Children's Medical Center, Tehran University of Medical sciences, Tehran, Iran
| | - Houman Alizadeh
- Radiology Division, Children's Medical Center, Tehran University of Medical sciences, Tehran, Iran
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Watanabe A, Suzuki H, Kubo N, Kobayashi T, Araki K, Sasaki S, Shimura T, Oyama T, Kuwano H. A case of mesenteric cystic lymphangioma in an adult which caused duodenal stenosis after resection. Int J Surg Case Rep 2012; 4:212-5. [PMID: 23287062 DOI: 10.1016/j.ijscr.2012.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/09/2012] [Accepted: 10/09/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We present a rare case of mesenteric lymphangioma in a middle-aged female. PRESENTATION OF CASE A 56-year-old female was admitted to the hospital with upper abdominal pain. Abdominal computed tomography revealed a multicystic mass surrounding the mesentery. We made the decision to resect the mass, suspecting that was a mesenteric lymphangioma based on additional imaging studies. The tumor adhered strongly to parts of the duodenum and the upper jejunum. In order to preserve the jejunum, we dissected its serosa away from the tumor. Approximately 1 week after surgery the patient experienced a constriction of the third portion of the duodenum. Her symptoms were improved with conservative therapy, and she was discharged from the hospital 62 days after surgery. DISCUSSION Lymphangioma originating from the mesentery may have cause adhesions due to exfoliated tumor cells; it is necessary to be concerned about postoperative obstruction. CONCLUSION The preoperative diagnosis of lymphangioma is based on various imaging modalities.
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Affiliation(s)
- Akira Watanabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Maebashi, Gunma 371-8511, Japan.
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Suthiwartnarueput W, Kiatipunsodsai S, Kwankua A, Chaumrattanakul U. Lymphangioma of the small bowel mesentery: A case report and review of the literature. World J Gastroenterol 2012; 18:6328-6332. [PMID: 23180956 PMCID: PMC3501784 DOI: 10.3748/wjg.v18.i43.6328] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lymphangioma is a rare benign condition characterized by proliferation of lymphatic spaces. It is usually found in the head and neck of affected children. Lymphangioma of the small-bowel mesentery is rare, having been reported for less than 1% of all lymphangiomas. Importantly, it can cause fatal complications such as volvulus or involvement of the main branch of the mesenteric arteries, requiring emergency surgery. Moreover, the gross and histopathologic findings may resemble benign multicystic mesothelioma and lymphangiomyoma. Immunohistochemical study for factor VIII-related antigen, D2-40, calretinin and human melanoma black-45 (HMB-45) are essential for diagnosis. Factor VIII-related antigen and D2-40 are positive in lymphangioma but negative in benign multicystic mesothelioma. HMB-45 shows positive study in the smooth-muscle cells around the lymphatic spaces of the lymphangiomyoma. We report a case of small-bowel volvulus induced by mesenteric lymphangioma in a 2-year-and-9-mo-old boy who presented with rapid abdominal distension and vomiting. The abdominal computed tomography scan showed a multiseptated mass at the right lower quadrant with a whirl-like small-bowel dilatation, suggestive of a mesenteric cyst with midgut volvulus. The intraoperative findings revealed a huge, lobulated, yellowish pink, cystic mass measuring 20 cm × 20 cm × 10 cm, that was originated from the small bowel mesentery with small-bowel volvulus and small-bowel dilatation. Cut surface of the mass revealed multicystic spaces containing a milky white fluid. The patient underwent tumor removal with small-bowel resection and end-to-end anastomosis. Microscopic examination revealed that the cystic walls were lined with flat endothelial cells and comprised of smooth muscle in the walls. The flat endothelial cells were positive for factor VIII-related antigen and D2-40 but negative for calretinin. HMB-45 showed negative study in the smooth-muscle cells around the lymphatic spaces. Thus, the diagnosis was lymphangioma of the small bowel mesentery with associated small bowel volvulus.
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Mesenteric cysts associated with recurrent small-bowel volvulus: cause or effect? Jpn J Radiol 2012; 30:858-62. [PMID: 22986751 DOI: 10.1007/s11604-012-0131-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 08/26/2012] [Indexed: 12/14/2022]
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.
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Abstract
Small bowel volvulus is a rare cause of bowel obstruction in the Western World. It is often divided into primary and secondary causes. This report presents a case of secondary ileal volvulus with underlying carcinoid tumour.
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Lymphatic angioma of mesentery of the small intestine: a case report. POLISH JOURNAL OF SURGERY 2011; 83:48-50. [PMID: 22166242 DOI: 10.2478/v10035-011-0007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors presented a rare case of lymphatic angioma of mesentery of the small intestine. The patient underwent successful surgery. The study presents clinical symptoms, diagnostic and therapeutic problems in patients with lymphatic angiomas.
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Chiappinelli A, Forgues D, Galifer RB. Congenital abdominal cystic lymphangiomas: what is the correct management? J Matern Fetal Neonatal Med 2011; 25:915-9. [DOI: 10.3109/14767058.2011.600364] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Papadimitriou G, Marinis A, Papakonstantinou A. Primary midgut volvulus in adults: report of two cases and review of the literature. J Gastrointest Surg 2011; 15:1889-92. [PMID: 21512851 DOI: 10.1007/s11605-011-1534-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 04/01/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This is a report of two male patients (35 and 54 years old, respectively) admitted to our surgical department with signs of small-bowel obstruction. CASE PRESENTATIONS Diagnostic workup with plain abdominal radiographs and, more specifically, computed tomography suggested the possibility of bowel rotation. In order to exclude any possibility of associated intestinal ischemia, both patients underwent exploratory laparotomy, which revealed a midgut volvulus without any associated obvious cause or pathology. DISCUSSION Both patients had an eventful outcome. Epidemiologic characteristics, clinical presentation, diagnostic workup, surgical treatment, and morbidity-mortality rates of small-bowel volvulus have been reviewed and thoroughly discussed.
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Abdominal Twists and Turns: Part I, Gastrointestinal Tract Torsions With Pathologic Correlation. AJR Am J Roentgenol 2011; 197:86-96. [DOI: 10.2214/ajr.10.7292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Maa J, Wa C, Jaigirdir A, Cho SJ, Corvera CU. Giant mesenteric cystic lymphangioma presenting with abdominal pain and masquerading as a gynecologic malignancy. Rare Tumors 2009; 1:e48. [PMID: 21139927 PMCID: PMC2994469 DOI: 10.4081/rt.2009.e48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 10/21/2009] [Indexed: 12/21/2022] Open
Abstract
Lymphangiomas are congenital malformations of the lymphatic system that account for about 5% of all benign tumors in infants and children.1 The most common sites are the neck and axilla, which account for 95% of cases.2 Abdominal cystic lymphangiomas are quite rare, and can arise from either the retroperitoneum, gastrointestinal tract, or the mesentery of the abdominal viscera.3 The presenting symptoms are painless abdominal distension, a palpable mass, or secondary complications in the abdomen such as intestinal obstruction, volvulus, intestinal infarction, or bleeding.4 Typically diagnosed during childhood, these tumors prompt surgical intervention. We describe an atypical case of an abdominal cystic lymphangioma, which did not manifest until adulthood, with atypical symptoms of a rapidly expanding and symptomatic mass.
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Affiliation(s)
- John Maa
- Department of Surgery, University of California
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Literature Watch. Lymphat Res Biol 2009. [DOI: 10.1089/lrb.2009.7203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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