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Dong J, Xin J, Shen W, Wen T, Chen X, Sun Y, Wang R. CT Lymphangiography (CTL) in Primary Intestinal Lymphangiectasia (PIL): A Comparative Study with Intraoperative Enteroscopy (IOE). Acad Radiol 2019; 26:275-281. [PMID: 29885759 DOI: 10.1016/j.acra.2018.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/28/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the clinical feasibility of CT lymphangiography (CTL) in primary intestinal lymphangiectasia (PIL) by comparison with intraoperative enteroscopy (IOE) during exploratory laparotomy. MATERIALS AND METHODS Eleven PIL patients (F/M, two/nine, age range 10-37 years) were recruited in this study, and they were performed IOE during exploratory laparotomy for suspected serious lymphatic-intestinal leakages. All the patients were performed CTL before surgery, and the imaging data were reviewed by two radiologists separately. CTL assessments included intestinal lesions, edematous lesions, intestinal and mesenteric lymphangiectasia, lymphaticabdominal leakages, lymph fluid reflux, lymphangioma and abnormal lymphatics in other area. The intestinal lymphangiectasia and lymphaticintestinal leakages were confirmed by histology and IOE. RESULTS For CTL, (1) nine intestinal wall thickening; (2) eight ascites, complicated with four pleural effusions, (3) eight intestinal and mesenteric lymphangiectasia, (4) six lymph fluid reflux (5) one lymphatic-abdominal leakage, (6) two lymphangioma. While for IOE, intestinal lymphangiectasia has been confirmed in all patients, including five segemental and six diffusive lesions in intestinal mucosa. Besides, one lymphatic-intestinal fistula, one lymphatic-abdominal leakage was confirmed. Compared to IOE and histology, the accuracy of CTL was 72.7% in detecting intestinal lymphangiectasia. CONCLUSION Compared to IOE, CTL demonstrates feasibility in detection of intestinal lymphangiectasia and other abnormalities in whole lymphatic circulation for PIL. Combination of CTL with IOE accommodates guidance for preoperative evaluation and therapeutic management for PIL.
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Affiliation(s)
- Jian Dong
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, China
| | - Jianfeng Xin
- Department of Lymphatic surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, China
| | - Wenbin Shen
- Department of Lymphatic surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, China
| | - Tingguo Wen
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, China
| | - Xiaobai Chen
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, China
| | - Yuguang Sun
- Department of Lymphatic surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, China
| | - Rengui Wang
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, China.
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Goel A, Gaur MK, Garg PK. Milky Mesentery: Acute Abdomen with Chylous Ascites. Indian Pediatr 2018; 55:909-910. [PMID: 30426960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Clinical presentations of intestinal lymphangiectasia include pitting edema, chylous ascites, pleural effusion, diarrhea, malabsorption and intestinal obstruction. CASE CHARACTERISTICS An 8-year-old male child presented to the emergency department with clinical features of peritonitis, raising suspicion of appendicular or small bowel perforation. INTERVENTION/OUTCOME Diagnosis of chylous ascites with primary intestinal lymphangiectasia made on laparotomy. MESSAGE Acute peritonitis may be a presentation of primary intestinal lymphangiectasia and chylous ascites.
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Affiliation(s)
- Aakanksha Goel
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India. Correspondence to: Dr Aakanksha Goel, House No 1 Sukh Vihar, Delhi 110 051, India.
| | - Manish Kumar Gaur
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Morozov DA, Pimenova ES, Tatochenko VK, Bakradze MD, Gadliya DD, Morozova OL, Talalaev AG. [Surgical treatment of rare combination of intestinal malrotation with secondary lymphangiectasia]. ACTA ACUST UNITED AC 2015:56-62. [PMID: 26027272 DOI: 10.15690/vramn.v70i1.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The rare combination of intestinal lymphangiectasia with malrotation of the duodenum in a child of three months of life is described. Basing on the literature review only 3 similar cases were described in the world practice. The boy with protein-losing enteropathy was examined at Moscow Scientific Centre of Children's Health. The child had vomiting, diarrhea, loss in body weight, hypoproteinemia, lymphopenia. The infectious nature of the disease was excluded. It had been suggested the Waldman desease (primary intestinal lymphangiectasia). The prognosis for such disease is unfavorable. An examination of the child was continued against the backdrop of ongoing symptomatic therapy. Complete physical examination included monitoring laboratory blood tests, X-ray examination with contrast, CT-scan, gastroduodenoscopy with biopsy of the mucosa of the small intestine. Malrotation duodenum with the recurrent mid-gut volvulus with the development of secondary intestinal lymphangiectasia was diagnosed. Modern methods of examination and multidisciplinary approach made it possible to diagnose the case. Operation to eliminate fixation duodenum resulted in the recovery of the patient. At the present time the child grows and develops according to age and does not require treatment. The prognosis for this disease is regarded as favorable.
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Zhu LH, Cai XJ, Mou YP, Zhu YP, Wang SB, Wu JG. Partial enterectomy: treatment for primary intestinal lymphangiectasia in four cases. Chin Med J (Engl) 2010; 123:760-764. [PMID: 20368101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Ling-hua Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, College of medicine; Institute of Micro-invasive Surgery, Zhejiang University, Hangzhou, Zhejiang 310016, China
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Abstract
UNLABELLED A 6-month-old male infant who presented with abdominal distension and congenital chylous ascites was diagnosed. He was initially refractory to conservative therapy, and then was completely cured with ligation of megalymphatics and fibrin glue application. Immunoperoxidase staining for CD31 on the biopsied peritoneal tissues highlighted the lining cells of lymphatic spaces, which indicated lymphangiectasia. CONCLUSION This case emphasizes the effectiveness of lymphatic ligation of the retroperitoneal megalymphatics in conjunction with fibrin glue application to cure congenital lymphangiectasia.
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Affiliation(s)
- N Densupsoontorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Kim NR, Lee SK, Suh YL. Primary intestinal lymphangiectasia successfully treated by segmental resections of small bowel. J Pediatr Surg 2009; 44:e13-7. [PMID: 19853733 DOI: 10.1016/j.jpedsurg.2009.06.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 06/25/2009] [Accepted: 06/29/2009] [Indexed: 12/12/2022]
Abstract
Primary intestinal lymphangiectasia is a rare cause of protein-losing enteropathy and usually presents with intermittent diarrhea or malnutrition. Diagnosis depends largely on its pathologic condition demonstrating greatly dilated lymphatics mainly in the lamina propria of the mucosa. We report a case of primary intestinal lymphangiectasia, of the diffuse type, presenting with abdominal pain and voluminous diarrhea in a previously healthy 8-year-old boy. He had periumbilical pain for 3 months before presentation. He was managed by segmental bowel resections and end-to-end anastomoses. The histopathologic condition of the resected small intestine showed lymphatic dilation limited mainly to the subserosa and mesentery but was not prominent in the mucosa. Abdominal pain and diarrhea subsided postoperatively. The present case is the fourth report describing a response to operative resection.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gil Medical Center, Gachon University of Medicine and Science, Incheon 405-760, Korea
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Herfarth H, Hofstädter F, Feuerbach S, Jürgen Schlitt H, Schölmerich J, Rogler G. A case of recurrent gastrointestinal bleeding and protein-losing gastroenteropathy. ACTA ACUST UNITED AC 2007; 4:288-93. [PMID: 17476211 DOI: 10.1038/ncpgasthep0812] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 03/05/2007] [Indexed: 01/05/2023]
Abstract
BACKGROUND A 40-year-old male with pentalogy of Fallot (a congenital heart defect with five anatomical components) presented with recurrent gastrointestinal bleeding. He had recently recovered from a heart operation, which was performed to reconstruct the right ventricular outflow tract. INVESTIGATIONS Laboratory tests and absorption tests, esophagogastroduodenoscopy, capsule endoscopy, human serum albumin scintigraphy, lymphoscintigraphy, CT and abdominal lymph-node histology. DIAGNOSIS Intestinal lymphangiectasia with concurrent protein-losing gastroenteropathy and recurrent gastrointestinal bleeding. MANAGEMENT Despite a low-fat diet and surgical suturing of multiple small-bowel ulcerations the gastrointestinal bleeding continued. Serum albumin levels remained very low and severe lymphedema occurred. Unfortunately, the patient developed severe sepsis and died of multiple organ failure.
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Affiliation(s)
- Hans Herfarth
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 27599, USA.
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Abstract
Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography (CT) are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.
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Affiliation(s)
- You-Hong Fang
- Department of Gastroenterlogy, The First Affiliated Hospital of College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China
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9
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Affiliation(s)
- Cihan Goktan
- Department of Radiology, Celal Bayar University Hospital, Mansia, Turkey.
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10
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Abstract
Intestinal lymphangiectasia, characterized by dilatation of intestinal lacteals, is rare. The major treatment for primary intestinal lymphangiectasia is dietary modification. Surgery to relieve symptoms and to clarify the etiology should be considered when medical treatment failed. This article reports a 49-year-old woman of solitary duodenal lymphangiectasia, who presented with epigastralgia and anemia. Her symptoms persisted with medical treatment. Surgery was finally performed to relieve the symptoms and to exclude the existence of underlying etiologies, with satisfactory effect. In conclusion, duodenal lymphangiectasia can present clinically as epigastralgia and chronic blood loss. Surgical resection may be resorted to relieve pain, control bleeding, and exclude underlying diseases in some patients.
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Affiliation(s)
- Chih-Ping Chen
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, China
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Connor FL, Angelides S, Gibson M, Larden DW, Roman MR, Jones O, Currie BG, Day AS, Bohane TD. Successful resection of localized intestinal lymphangiectasia post-Fontan: role of (99m)technetium-dextran scintigraphy. Pediatrics 2003; 112:e242-7. [PMID: 12949320 DOI: 10.1542/peds.112.3.e242] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Intestinal lymphangiectasia is a well-recognized complication of the Fontan procedure, occurring in up to 24% of patients. Because of the loss of chylous fluid into the gut lumen, protein-losing enteropathy results as well as lymphopenia and hypogammaglobulinaemia. In some cases, dilated lymphatics in the intestinal serosa or mesentery also rupture, causing chylous ascites. Standard medical and cardiac surgical interventions are generally ineffective and the condition is frequently lethal. We report a case of intractable and life-threatening chylous ascites and chylothorax in a 14-year-old girl, associated with intestinal lymphangiectasia and protein-losing enteropathy after a Fontan procedure for tricuspid atresia. The condition was refractory to all standard medical therapies, including dietary modifications, diuretics, corticosteroid therapy, albumin infusions, octreotide, heparin, bowel rest, and parenteral nutrition. Cardiac surgery to optimize her hemodynamic status was also ineffective and large volume pleural and ascitic fluid losses continued. Having exhausted all other therapeutic modalities, (99m)technetium-dextran scintigraphy was performed to assess the extent of intestinal protein loss and the potential for surgical intervention. Scintigraphy suggested localized protein loss from the proximal jejunum and subsequent segmental resection was effective. Postoperatively, ascites and pleural effusions resolved, and there was no evidence of short bowel syndrome. Growth has accelerated and the patient has entered puberty. There is mild persistent intestinal protein loss requiring diuretic therapy. Ascites or pleural effusions are absent, and the patient remains well >2 years after surgery. Intestinal lymphangiectasia post-Fontan procedures has traditionally been ascribed to hemodynamic factors such as raised systemic venous pressure, which would predispose to a generalized intestinal lesion. However, in this case, scintigraphy demonstrated a localized, surgically correctible lesion. To our knowledge, this is the first reported case of the use of (99m)technetium-dextran scintigraphy for this indication and of successful partial small bowel resection in such a case.
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Affiliation(s)
- Frances L Connor
- Department of Gastroenterology, Sydney Children's Hospital, NSW, Australia
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12
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Campbell DI, Beath SV, deVille de Goyet J, Thomas AG, Booth IW, Milford D, McKiernan PJ, Kelly DA. Severe intestinal lymphangiectasia complicated by nephrotic syndrome treated by small bowel, liver, and kidney transplantation. J Pediatr Gastroenterol Nutr 2003; 36:278-82. [PMID: 12548067 DOI: 10.1097/00005176-200302000-00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D I Campbell
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK.
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13
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Uğuralp S, Mutus M, Kutlu O, Cetin S, Baysal T, Mizrak B. Primary intestinal lymphangiectasia: a rare disease in the differential diagnosis of acute abdomen. J Pediatr Gastroenterol Nutr 2001; 33:508-10. [PMID: 11698774 DOI: 10.1097/00005176-200110000-00019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- S Uğuralp
- Department of Pediatric Surgery, Turgut Ozal Medical Center, Malatya, Turkey.
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14
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Abstract
HISTORY A 32-year-old man had ten years previously undergone several laparotomies for recurrent ileus of the small intestine. They revealed severe intestinal oedema and histology showed hyperplasia of the lymphatic system but the aetiology was unclear. After a 10-year interval free of symptoms he presented with marked hypoproteinaemic oedema and exudative enteropathy the cause of which was to be clarified by exploratory laparotomy with excision of lymph nodes and a small section of small intestine. INVESTIGATIONS Histology revealed intestinal lymphangiectasis with partly hyperplastic lymphoid tissue. Lymphangiography demonstrated several lymph nodes in the region of the aortic bifurcation and renal vessels with a central filling defect. It is thought likely that obstruction to lymphatic flow in this region resulted in oedema of the intestinal wall which caused the recurrent episodes of ileus. DIAGNOSIS Retrospectively it is assumed that primary intestinal lymphangiectasis was responsible for the initial manifestation of an acute abdomen. For treatment of hypoproteiaemia with human albuminea prot system was implanted. The course was complicated by recurrent inflammation and thrombosis of the port catheter. Because of immune deficiency risk of carcinoma is high in primary intestinal lymphangiectasis. CONCLUSION Primary intestinal lymphangiectasis, even though a rare condition, should be considered in the differential diagnosis of otherwise unclear acute abdomen.
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Affiliation(s)
- H Bantel
- Abteilung Gastroenterologie, Hepatologie und Infektiologie, Universität Tübingen
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Menon P, Hitchcock R. Unusual vascular dysplasia presenting as an intra-abdominal catastrophe. Pediatr Surg Int 1999; 15:440-1. [PMID: 10415315 DOI: 10.1007/s003830050628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A case of severe, generalised vascular dysplasia presenting as an intra-abdominal catastrophe is reported. Associated clinical features included cutis marmorata telangiectatica congenita, congenital glaucoma, hypertension, and focal fits. The case has been reported in view of its rarity and nature of presentation.
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Affiliation(s)
- P Menon
- Department of Paediatric Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU
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16
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Kaushik R, Kaushik SL, Sharma J, Sharma BB. Lymphangiectasia of small intestine. Indian Pediatr 1999; 36:617-9. [PMID: 10736604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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18
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Abstract
Intestinal lymphangiectasia is a common cause of protein-losing enteropathy characterized by diarrhea, generalized edema, enteric protein loss, hypoproteinemia, and lymphopenia. Diagnosis is based on demonstration of enteric protein loss and characteristic small bowel mucosal histology. Various imaging modalities including barium studies, computed tomography, and lymphangiography have had limited clinical use. The authors report a case of intestinal lymphangiectasia in which Tc-99m dextran lymphoscintigraphy played a significant role in the patient management.
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Affiliation(s)
- T C Yueh
- Department of Nuclear Medicine, First Affiliated Hospital of Sun Yat-Sen, University of Medical Sciences, Guangzhou, Peoples Republic of China
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19
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Abstract
Intestinal lymphangiectasia is a rare disorder, usually presenting with protein-losing enteropathy leading to oedema and ascites. We describe a case that presented as an acute surgical emergency with pain and a mass in the right iliac fossa, which was successfully treated by resection of the involved segment of ileum.
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Affiliation(s)
- J S Jameson
- Department of Surgery, Leicester General Hospital, UK
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20
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Mercurella A, Galloni E, Danti S, Valli F, Colombo B, Belloli G. [Primary intestinal lymphangiectasis. A case treated surgically]. Pediatr Med Chir 1990; 12:195-9. [PMID: 2235665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The authors describe a rare case of primary intestinal lymphangiectasis resolved with surgical treatment. Usually the natural course of the disease is relatively mild and medical nutritional treatment can be sufficient. In this case the lymphatic intestinal anomaly was generalized to the entire small intestine but a distal ileal segment was particularly involved. The surgical resection of this intestinal tract resolved the symptomatology.
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Affiliation(s)
- A Mercurella
- Divisione di Chirurgia Pediatrica, Ospedale Regionale, Vicenza, Italia
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21
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Abstract
Congenital defects of lymphatics constitute a spectrum of disorders that may manifest with a variety of clinical presentations including lymphedema, chylous effusions, lymphangiomatous malformations with cystic masses and localized gigantism, and intestinal lymphangiectasia with malabsorption. These entities constitute a relatively rare group of disorders, the origin of which remains somewhat controversial, but in some it appears to be due to early lymphatic obstruction. Five cases are described, which demonstrate the anatomical pathology of these entities. A classification and description of the defects is also presented. An attempt is made to present a unified theory of origin for this seemingly diverse group of diseases. While these entities may be challenging from a diagnostic and therapeutic standpoint, a wide variety of imaging modalities, which includes lymphography, computed tomography scanning, and ultrasound, may be used to diagnose the extent and internal structural characteristics of the abnormalities.
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Affiliation(s)
- C Levine
- Department of Radiology, University of Missouri-Columbia Hospital 65212
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23
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Thompson JM, Brett A, Rose SJ. Dietary management of intestinal lymphangiectasia complicated by short gut syndrome. Hum Nutr Appl Nutr 1986; 40:136-40. [PMID: 3700137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The dietary management of a child with intestinal lymphangiectasia complicated by short gut syndrome following surgery at the age of 3 weeks is described. Diets containing amino acids and peptides were not tolerated due to high osmolality. Satisfactory nutrition was achieved by using a feed with low osmolality and containing whole whey protein, maltodextrin, medium-chain triglycerides (MCT) and a small amount of long-chain triglycerides (LCT) to supply essential fatty acids (RD231).
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Kato S, Asakura H, Miura S, Hamada Y, Ichikawa E. [Rare case of protein-losing intestinal lymphangiectasia]. Nihon Shokakibyo Gakkai Zasshi 1985; 82:1765-70. [PMID: 4079094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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25
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Abstract
In a 27-year-old patient suffering from Crohn's disease covering nearly the entire small intestine, the major problem was a marked protein-losing enteropathy which required long-term intravenous replacement. Accidentally, we disclosed a dilated thoracic duct with incompetent valves and stenosis at the junction into the subclavian vein in this patient. To reduce the intestinal protein loss, an anastomosis was performed between the thoracic duct and the internal jugular vein. Subsequently the intestinal protein loss dropped from 40 to 26% and replacement of proteins could be reduced. The patient was observed for 4 years postoperatively and the therapeutic effect continued. Besides this therapeutic aspect, the present case gives cause to consider the possible role of the lymphatics in the pathogenesis of Crohn's disease.
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Agulló Martí J, Varea Calderón V, Vila Escrigas PJ, Amat Ballarín L, Cot Martínez X, Sotoca J. [Complex lymphatic malformation as a cause of ascites in the infant]. An Esp Pediatr 1984; 20:77-9. [PMID: 6703538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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27
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Abstract
A 36-mo-old boy with Milroy's Disease, intestinal lymphangiectasia, and an exudative enteropathy (EE), was shown to have four colonic polyps. A large adenomatous polyp was excised from the transverse colon in an effort to control his EE and hypoalbuminemia (1.95 g/dl). His clinical status then stabilized until age 50 mo when there was a marked exacerbation of his EE. Medical management resulted in a temporary stabilization of his condition. A partial resection (40 cm) of the visually worse affected jejunum was performed. There was no improvement in the EE as measured by 51Cr-tagged albumin study; however, his clinical response was dramatic. In the 10 mo since surgery, he has been well and has shown catchup in linear growth.
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28
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Simpson AJ, Amer H. The radiology corner. Segmental lymphangiectasia of the small bowel. Am J Gastroenterol 1979; 72:95-100. [PMID: 463857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A case of intestinal lymphangiectasia, limited to a small segment of jejunum, is reported. This finding reflects part of the spectrum of generalized dysplasia of the lymphatic system. A discussion of the pathogenesis, pathophysiology and roentgen features of intestinal lymphangiectasia as part of a systemic disorder is presented.
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Vardy PA, Lebenthal E, Shwachman H. Intestinal lymphagiectasia: a reappraisal. Pediatrics 1975; 55:842-51. [PMID: 1134884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Intestinal lymphangiectasia (IL) may vary widely in its manifestations and severity. Fifteen children seen between 1960 and 1974 with histologically proven IL are analyzed by clinical, laboratory, radiologic, and histologic criteria. Remissions occurred in most patients and none died. Exacerbations occurred in five children. Diarrhea was present in 14 patients and in 13 appeared before the age of 3 years. Vomiting occurred in nine patients and growth retardation in seven. Four children had associated peripheral lymphedema and two of these had a family history of lymphedema, both had affected fathers and one had affected siblings and paternal cousins. Seven had hypoproteinemic edema, and of these, four suffered from hypocalcemic seizures. Chylous effusions were present in five. Hypoproteinemia was present in 12 although five had no hypoalbuminemic edema. Six had lymphopenia which was related to the severity of the disease and was the last abnormality to disappear after clinical remission. Lymphopenia may first appear years after the protein loss begins. Upper gastrointestinal tract series were performed in 13 children and had diagnostic supportive value in seven. Six children had two or more small-intestinal biopsies done. They all showed great variation from one examination to the other, ranging from a normal appearance to severe changes. Lymphatic block may occur at different sites-in the lamina propria only, generalized (lamina propria, submucosa, serosa, and mesentery), or conversely in the mesentery alone with minimal changes in the lamina propria. In three patients intravenous hyperalimentation was necessary. Specific treatment with a high-protein, low-fat diet with added medium-chain triglyceride (MCT) is valuable. Surgical resection was of benefit in one patient, and anastomosis of mesenteric to para-aortic lymph nodes in another.
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Dall'antonia F, Farello GA. [Intestinal lymphagiectasis of surgical interest]. MINERVA CHIR 1975; 30:201-4. [PMID: 1226235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Surgical management of a case of intestinal lymphangectasis with unusual features is reported. The view that the picture was one of early segmentary enteritis was supported by some aspects of the course and various anatomopathological features.
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Capron JP, Pessayre D, Bitoun A, Degott C, Erlinger S. [Primary intestinal lymphangiectasia, chronic hepatitis and australia antigen]. Arch Fr Mal App Dig 1974; 63:223-8. [PMID: 4447433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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