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Hoskins B, Song W, Guerrerio AL. Secondary Intestinal Lymphangiectasia. J Pediatr Gastroenterol Nutr 2024; 78:166. [PMID: 38291682 DOI: 10.1097/mpg.0000000000003936] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Brett Hoskins
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Weihua Song
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anthony L Guerrerio
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
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2
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Norman JS, Testa S, Wang CX, Savage T. Milky Way: Management of Primary Intestinal Lymphangiectasia. Dig Dis Sci 2023; 68:3872-3877. [PMID: 37634185 DOI: 10.1007/s10620-023-08077-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Joshua S Norman
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA.
- , Stanford, USA.
| | - Stefano Testa
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA
| | - Cindy Xinnan Wang
- Department of Pathology, Stanford University, Stanford, CA, 94304, USA
| | - Thomas Savage
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA
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3
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Card KR, Kalafatis NE, Lally SE, Pulido JS, Shields CL. Choroidal effusion and serous retinal detachment in protein-losing enteropathy from intestinal lymphangiectasia. Can J Ophthalmol 2023; 58:e229-e231. [PMID: 37192734 DOI: 10.1016/j.jcjo.2023.04.009] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/19/2023] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Kevin R Card
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | | | - Sara E Lally
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jose S Pulido
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Carol L Shields
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA.
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Feng H, Zou L, Zhai X, Zhang S, Li J. Hypomagnesemia in intestinal lymphangiectasia: a case report and review of the literature. BMC Gastroenterol 2022; 22:246. [PMID: 35570283 PMCID: PMC9107688 DOI: 10.1186/s12876-022-02318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intestinal lymphangiectasia (IL) is a rare disease characterized by dilation of lymphatic vessels and leakage of lymphatic fluids into the intestinal lumen, causing depletion of lymphocytes, protein, lipids, fat-soluble vitamins, and electrolytes. Hypomagnesemia can occur in IL patients but is seldom discussed. CASE PRESENTATION A 30-year-old Tibetan woman who had chronic diarrhea, edema, tetany, and tingling was diagnosed with IL. Prominent hypomagnesemia was noticed. She was treated with a medium-chain triglyceride (MCT) diet and nutrient supplementation with satisfactory results. We also present a systematic review of hypomagnesemia in IL cases from the published literature. CONCLUSIONS Hypomagnesemia may be an overlooked complication of IL, thus monitoring serum magnesium concentrations in IL patients is crucial.
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Affiliation(s)
- Hao Feng
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Linfeng Zou
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiao Zhai
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shengyu Zhang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Jingnan Li
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
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Huber R, Semmler G, Mayr A, Offner F, Datz C. Primary intestinal lymphangiectasia in an adult patient: A case report and review of literature. World J Gastroenterol 2020; 26:7707-7718. [PMID: 33505146 PMCID: PMC7789053 DOI: 10.3748/wjg.v26.i48.7707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary intestinal lymphangiectasia (PIL), first described in 1961, is a rare disorder of unknown etiology resulting in protein-losing enteropathy. The disease is characterized by dilatation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia, and lymphopenia. Since the severity and location of lymph vessels being affected can vary considerably, the range of associated symptoms is wide from mild lower-limb edema to generalized edema, abdominal and/or pleural effusion, and recurrent diarrhea, among others. Although usually developing in early childhood, we present the case of a 34-year-old woman with PIL. Moreover, we performed a literature review systematically assessing clinical presentation, and provide a practical approach to facilitate diagnosis and therapy of PIL in adults.
CASE SUMMARY Our patient presented with unspecific symptoms of abdominal discomfort, fatigue, nausea, and recurrent edema of the lower limbs. Interestingly, a striking collinearity of clinical symptoms with female hormone status was evident. Additionally, polyglobulia, hypoalbuminemia, hypogammaglobulinemia, and transient lymphocytopenia were evident. Due to suspicion of a bone marrow disease, an extensive diagnostic investigation was carried out excluding secondary causes of polyglobulinemia and hypoalbuminemia. The diagnosis of primary intestinal lymphangiectasia was established after 22 wk by histological analysis of biopsy samples obtained via enteroscopy. Consecutively, the patient was put on a high-protein and low-fat diet with medium-chain triglycerides supplementation leading to significant improvement of clinical symptoms until 2 years of follow-up.
CONCLUSION PIL can be the reason for cryptogenic hypoalbuminemia, hypogammaglobulinemia, and lymphopenia in adulthood. Due to difficulty in correct diagnosis, treatment initiation is often delayed despite being effective and well-tolerated. This leads to a significant disease burden in affected patients. PIL is increasingly been recognized in adults since the majority of case reports were published within the last 10 years, pointing towards an underestimation of the true prevalence. The association with female hormone status warrants further investigation.
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Affiliation(s)
- Rudolf Huber
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
| | - Georg Semmler
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
| | - Alexander Mayr
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
| | - Felix Offner
- Department of Pathology, General Hospital Feldkirch, Feldkirch 6800, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
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Singh AK, Zameer A, Sood R, Verma S, Samanta J, Bal A, Sinha SK, Kochhar R. Chronic diarrhea with white colon: primary intestinal lymphangiectasia. QJM 2020; 113:886-887. [PMID: 32330275 DOI: 10.1093/qjmed/hcaa139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 04/11/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - R Sood
- Department of Pathology, Post-Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - S Verma
- Department of Gastroenterology
| | | | - A Bal
- Department of Pathology, Post-Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
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7
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837'||dbms_pipe.receive_message(chr(98)||chr(98)||chr(98),15)||'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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8
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837����%2527%2522\'\"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837aaratki3')) or 121=(select 121 from pg_sleep(15))--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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10
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837ovh6hss9'; waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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11
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837-1 waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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12
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837'"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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13
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837pu8kyict'); waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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14
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837-1 waitfor delay '0:0:3' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837eyndbx2c' or 921=(select 921 from pg_sleep(15))--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.14837pjqyeny6')); waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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17
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Lopez RN, Day AS. Primary intestinal lymphangiectasia in children: A review. J Paediatr Child Health 2020; 56:1719-1723. [PMID: 32463559 DOI: 10.1111/jpc.148375hm9hagd') or 645=(select 645 from pg_sleep(15))--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia is an uncommon condition that usually presents early in childhood. This incurable condition is consequent to underlying lymphatic abnormalities that lead to loss of lymphatic contents into the intestinal lumen. This article outlines an approach to the assessment of children presenting with characteristic features and consideration of other conditions that could lead to enteric protein loss. An overview of the management of primary intestinal lymphangiectasia is outlined.
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Affiliation(s)
- Robert N Lopez
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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Fattorusso A, Pieri ES, Dell’Isola GB, Prontera P, Mencaroni E, Stangoni G, Esposito S. Intestinal lymphangiectasia in a 3-month-old girl: A case report of Hennekam syndrome caused by CCBE1 mutation. Medicine (Baltimore) 2020; 99:e20995. [PMID: 32629717 PMCID: PMC7337536 DOI: 10.1097/md.0000000000020995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONAL Intestinal lymphangiectasia (IL) is a rare disease characterized by dilatation and rupture of intestinal lymphatic channels leading to protein-losing enteropathy. IL is classified as primary and secondary types. PATIENT CONCERNS A 3-month-old girl born at term from vaginal delivery with an APGAR score of 10/10 and birth weight of 4.310 g (>97° percentile) was admitted to our hospital because of increasing abdominal tenderness and diarrhea. At first examination, she presented an abdominal circumference of 60 cm, edema of the lower extremities and vulva, and facial dysmorphisms (hypertelorism, flat nasal bridge, flat mid-face). DIAGNOSIS Once admitted, ultrasonography showed a large amount of ascites, while blood laboratory investigations revealed severe hypoproteinemia, hypoalbuminemia and hypogammaglobulinemia. Lymphoscintigraphy with 99m-Tc-nanocolloid demonstrated abnormal leakage of the tracer in the abdomen as evidence of IL. To detect a possible secondary, exams were performed and demonstrated positive antibody titres for CMV-IgM and IgG in blood and CMV-DNA positivity in blood, urine, saliva, maternal milk, and gastric and duodenal biopsies. Genetic investigations identified the genomic variant c.472C>T of the CCBE1 gene, coding for a protein variant (p.Arg158Cys), in homozygosity. INTERVENTIONS Total parenteral nutrition was started and continued for a total of 18 days, then gradually bridged by enteral nutrition with a special formula. In addition, antiviral therapy for CMV infection was added first with intravenous ganciclovir for 14 days, resulting in the disappearance of blood viral load after 7 days of therapy and then with valganciclovir per os for another 30 days. OUTCOMES The clinical course of the child gradually improved. A few days after starting treatments, lower extremities and vulvar edema disappeared, and abdominal circumference gradually decreased to a stable value of 38 cm, without any ultrasonographic signs of ascites left. Moreover, serum albumin and IgG rose to normal values after 3 months (4.3 g/dL and 501 mg/dL, respectively). LESSONS This case suggests that in presence of IL both primary and secondary causes should be evaluated. On the other hand, genetic diagnosis is crucial not only for diagnosis but also for prognosis in HS. Life expectancy and quality could deeply vary among different gene mutations and protein variants of the same gene. Further studies and case reports are needed to better understand the clinical meaning of these genetic results and the role of CMV as trigger of IL.
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Affiliation(s)
- Antonella Fattorusso
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia
| | - Elena Sofia Pieri
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia
| | | | - Paolo Prontera
- Center for Rare Diseases, Azienda Ospedaliera Santa Maria della Misericordia, Perugia
| | - Elisabetta Mencaroni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia
| | - Gabriela Stangoni
- Center for Rare Diseases, Azienda Ospedaliera Santa Maria della Misericordia, Perugia
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Affiliation(s)
- Y-J Tseng
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, China
| | - W-Q Ding
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, China
| | - Z-G Luo
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, China
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Agrawal A, Pandey VP, Shende A. Primary Intestinal Lymphangiectasia (Waldmann's Disease) A Rare Case of Protein Losing Enteropathy. J Assoc Physicians India 2020; 68:89. [PMID: 31979845] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - V P Pandey
- MGM Medical College and MY Hospital, Indore, MP
| | - Atul Shende
- MGM Medical College and MY Hospital, Indore, MP
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21
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Kumar S, Raja K, Gnanasekaran S, Pottakkat B. Intestinal lymphangiectasia: a rare cause of intussusception in an adolescent. Ann R Coll Surg Engl 2019; 101:e43-e44. [PMID: 30322285 PMCID: PMC6351867 DOI: 10.1308/rcsann.2018.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 11/22/2022] Open
Abstract
Intussusception in adolescents is usually idiopathic in nature. A 17-year-old woman with diffuse large B cell lymphoma presented with signs of intestinal obstruction after initiation of induction chemotherapy. On evaluation, the patient was diagnosed to have ileoileal intussusception with intestinal lymphangiectasia as the lead point. Intestinal lymphangiectasia as a rare cause for intussusception and its relationship with lymphoma is discussed in this case report.
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Affiliation(s)
- S Kumar
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, Puducherry, India
| | - K Raja
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, Puducherry, India
| | - S Gnanasekaran
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, Puducherry, India
| | - B Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, Puducherry, India
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22
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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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23
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Usnayo Usnayo KM, Piscoya A, Escalante Kanashiro R, Sánchez Dávila S. [Primary intestinal lymphangiectasia: first case report in Peru]. Rev Gastroenterol Peru 2019; 39:78-80. [PMID: 31042241] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Primary intestinal lymphangiectasia is a rare clinical condition of unknown etiology. The common age of presentation is during the first 3 years of life, but cases in adults have also been reported. It has a variable symptomatology, but the main clinical manifestation is edema, also diarrhea and weight loss can occur. The loss of lymph fluid into the gastrointestinal tract also leads to hypoproteinemia and lymphopenia. Diagnosis is based on clinical manifestations, laboratory and endoscopic findings, and is confirmed on histopathological examination of biopsy. The main treatment is a protein rich, low in fat and medium chain triglyceride diet. We present the case of a 1-year-old male patient who presents with generalized edema, predominantly in lower limbs, and diarrhea. Laboratory findings show the presence of marked hypoproteinemia. Then an endoscopy and a duodenal biopsy are performed, and the histopathological study confirms the diagnosis of primary intestinal lymphangiectasia. The patient is treated and after a satisfactory evolution, is discharged.
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Affiliation(s)
| | - Alejandro Piscoya
- Servicio de Gastroenterología, Hospital Guillermo Kaelin de la Fuente. Lima, Perú; Vicerrectorado de Investigación, Universidad San Ignacio de Loyola. Lima, Perú
| | - Raffo Escalante Kanashiro
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas. Lima, Perú; Instituto Nacional de Salud del Niño. Lima, Perú
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24
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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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25
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Van de Bruaene C, Hertveldt K, Van Avermaet S. In search of albumin: An unusual case of lower limb edema. Eur J Intern Med 2018; 50:e3-e4. [PMID: 28697951 DOI: 10.1016/j.ejim.2017.07.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Cedric Van de Bruaene
- Ghent University Hospital, Department of Gastroenterology, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Koen Hertveldt
- AZ Sint-Jan, Department of Histopathology, Kaïrostraat 84, 8400 Oostende, Belgium
| | - Steven Van Avermaet
- AZ Sint-Jan, Department of Gastroenterology, Kaïrostraat 84, 8400 Oostende, Belgium
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26
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Guo S, Song L, Guan DX, Mei TL, Zhou J, Yu FH, Wang GL, Zhang J, Shen HQ, Xu XW. [Clinical analysis of intestinal lymphangiectasia in 47 children]. Zhonghua Er Ke Za Zhi 2017; 55:937-941. [PMID: 29262475 DOI: 10.3760/cma.j.issn.0578-1310.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To analyze the clinical manifestations, diagnosis, treatment and prognosis of intestinal lymphangiectasia (IL) in children in order to improve the skills of diagnosis and treatment of IL. Method: Clinical manifestations, laboratory findings, gastroscopic findings, histopathological examinations and lymphatic radionuclide imaging assessments were analyzed retrospectively among 47 IL patients who were hospitalized in the Gastroenterology Department of Beijing Children's Hospital Affiliated to Capital Medical University from June 2007 to December 2015. All patients were followed up by telephone. According to the various causes, the patients were divided into the primary intestinal lymphangiectasia (PIL) group and secondary IL group, and their clinical manifestations were compared by t test, Rank sum test or Chi-square test. Result: In 47 IL patients, there were 38 children (81%) younger than 3 years old. There were 43 PIL patients (91%) and 4 secondary IL patients (9%). Between PIL and secondary IL, there were statistical differences in serum albumin (t=-3.950, P<0.005) , globulin(t=-2.850, P=0.007), age of onset(U=27.000, P=0.024), age at diagnosis(U=29.000, P=0.030) and course of disease(U=26.500, P=0.023), whereas there were no statistical differences in lymphocyte count, IgG, lymphatic radionuclide imaging, histopathology and gender(all P>0.05). Edema (44 cases, 94%), diarrhea (42 cases, 89%), accompanied with infection (35 cases, 74%) and ascites (30 cases, 64%) were the main clinical manifestations. In 47 IL patients, 45 patients were done gastroscopy and histopathological examinations, and there were 31 patients' histopathological examinations(69%) were positive. Forty patients were done lymphatic radionuclide imaging, and there was evidence of protein losing from gut via lymphatic radionuclide imaging in 39 patients(98%). Among 47 patients, 35 patients (74%) were followed up, 32 patients had good prognosis, 2 patient failed to show evidence of improvement, 1 patient died and no patient experienced a relapse till the end of the follow-up. In 35 patients, 28 patients were treated with medium chain triglycerides (MCT) dietary therapy, 26 patients showed improvement in symptoms, and 2 patients had no improvement. Among 35 patients with follow-up, there were 6 patients received surgical treatment, and their symptoms were improved. Conclusion: PIL are the majority of IL in children younger than 3 years old. The main clinical manifestations are edema, diarrhea, accompanied with infection and ascites. For the patients without the evidence of lymphangiectasia from duodenum histopathological examination, further consideration of lymphatic radionuclide imaging, clinical manifestations, and laboratory studies are needed to make a final diagnosis. MCT dietary therapy is the cornerstone of IL medical management.
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Affiliation(s)
- S Guo
- Department of Gastroenterology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
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27
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Abstract
Lymphoedema is the build-up of lymphatic fluid leading to swelling in the tissues. Most commonly it affects the peripheries. Diagnosis is based on clinical assessment and imaging with lymphoscintigraphy. Treatment is supportive with compression garments, massage, good skin hygiene and prompt use of antibiotics to avoid the complication of cellulitis. Most commonly, lymphoedema occurs as a result of damage to the lymphatic system following surgery, trauma, radiation or infection. However, it can be primary, often associated with a genetic defect that causes disruption to the development of the lymphatic system. Common genetic conditions associated with lymphoedema include Turner syndrome and Noonan syndrome; however, there are numerous others that can be classified based on their clinical presentation and associated features. Herein we discuss how to diagnose and classify the known primary lymphoedema conditions and how best to investigate and manage this group of patients.
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Affiliation(s)
- Gabriela E Jones
- Department of Clinical Genetics, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Sahar Mansour
- Department of Clinical Genetics, St Georges Hospital and St George’s, University of London, London, UK
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28
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Abstract
RATIONALE Intestinal lymphangiectasia (IL) is a rare enteropathy involving the expansion and rupture of intestinal lymphatic channels. Although several reports have studied cases of primary IL (PIL), this condition is very rare, and is even less commonly encountered in infants. This study aimed to investigate the nutritional therapy and effect assessment of chylous reflux disorder caused by PIL in infants. PATIENT CONCERNS Infantile patients were enrolled in the Affiliated Beijing Shijitan Hospital of the Capital Medical University between January 2012 and March 2014. The minimum age of onset was 4 months and the maximum age of onset was 16 months, with an average age of 4.9 months. DIAGNOSES All children were inpatient who had been diagnosed with chylous reflux syndrome (chylothorax and/or chylic abdomen) caused by PIL. INTERVENTIONS Retrospective analysis and individualized nutrition therapy of these cases were carried out. Finally, nutritional therapy and prognosis of PIL were assessed and summarized. OUTCOMES All the children survived, showed improvement in the serum total protein, albumin, and HGB levels after nutritional therapy. After comprehensive nutritional therapy, we were able to achieve diarrhea control for all the 9 patients, and after treatment, the children passed soft, yellow stools 1 to 2 times/d. After treatment, the height and weight of all patients increased to within the normal ranges of the World Health Organization standard chart. The mean serum albumin level reached 41.3 g/L. All nutrition-related indicators were found to have significant improvement compared with the baseline levels. LESSONS The results revealed that nutritional therapy for the 9 children with PIL was effective, and it may be able to improve the clinical syndromes and symptoms of children with PIL and promote recovery.
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Affiliation(s)
- Suyun Li
- Department of Nutrition, Beijing Shijitan Hospital, Capital Medical University
| | - Xiaoqian Liu
- Department of Nutrition, Beijing Shijitan Hospital, Capital Medical University
| | - Yuan He
- Department of Nutrition, Beijing Shijitan Hospital, Capital Medical University
| | - Qianyu Li
- Department of Nutrition, Beijing Shijitan Hospital, Capital Medical University
| | - Linlin Ji
- Department of Nutrition, Beijing Shijitan Hospital, Capital Medical University
| | - Wenbin Shen
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University
| | - Guansheng Tong
- Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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29
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Huber X, Degen L, Muenst S, Trendelenburg M. Primary intestinal lymphangiectasia in an elderly female patient: A case report on a rare cause of secondary immunodeficiency. Medicine (Baltimore) 2017; 96:e7729. [PMID: 28767614 PMCID: PMC5626168 DOI: 10.1097/md.0000000000007729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Protein loss via the gut can be caused by a number of gastrointestinal disorders, among which intestinal lymphangiectasia has been described to not only lead to a loss of proteins but also to a loss of lymphocytes, resembling secondary immunodeficiency. We are reporting on a 75-year-old female patient who came to our hospital because of a minor stroke. She had no history of serious infections. During the diagnostic work-up, we detected an apparent immunodeficiency syndrome associated with primary intestinal lymphangiectasia. Trying to characterize the alterations of the immune system, we not only found hypogammaglobulinemia and lymphopenia primarily affecting CD4+, and also CD8+ T cells, but also marked hypocomplementemia affecting levels of complement C4, C2, and C3. The loss of components of the immune system most likely was due to a chronic loss of immune cells and proteins via the intestinal lymphangiectasia, with levels of complement components following the pattern of protein electrophoresis. Thus, intestinal lymphangiectasia should not only be considered as a potential cause of secondary immune defects in an elderly patient, but can also be associated with additional hypocomplementemia.
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Affiliation(s)
- Xaver Huber
- Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland Medical Outpatient Department, University Hospital Basel, University of Basel, Basel, Switzerland Department of Gastroenterology and Hepatology, University Hospital Basel, University of Basel, Basel, Switzerland Institute of Pathology, University Hospital Basel, Basel, Switzerland
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30
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Martins CR, Gagnaire A, Rostain F, Lepage C. Waldmann's disease: a rare cause of protein losing enteropathy in an adult patient. Rev Esp Enferm Dig 2017; 109:385-388. [PMID: 28376626 DOI: 10.17235/reed.2017.4593/2016" and 2*3*8=6*8 and "bpxm"="bpxm] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. Since there are no accurate serological or radiological available tests, enteroscopy with histopathological examination based on intestinal biopsy specimens is currently the gold standard diagnostic modality of intestinal lymphangiectasia. We report a rare case of a primary intestinal lymphangiectasia in a 60-year-old Caucasian female who presented with asymptomatic hypoalbuminemia and hypogammaglobulinemia. After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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31
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Martins CR, Gagnaire A, Rostain F, Lepage C. Waldmann's disease: a rare cause of protein losing enteropathy in an adult patient. Rev Esp Enferm Dig 2017; 109:385-388. [PMID: 28376626 DOI: 10.17235/reed.2017.4593/2016' and 2*3*8=6*8 and 'evpx'='evpx] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. Since there are no accurate serological or radiological available tests, enteroscopy with histopathological examination based on intestinal biopsy specimens is currently the gold standard diagnostic modality of intestinal lymphangiectasia. We report a rare case of a primary intestinal lymphangiectasia in a 60-year-old Caucasian female who presented with asymptomatic hypoalbuminemia and hypogammaglobulinemia. After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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32
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Martins CR, Gagnaire A, Rostain F, Lepage C. Waldmann's disease: a rare cause of protein losing enteropathy in an adult patient. Rev Esp Enferm Dig 2017; 109:385-388. [PMID: 28376626 DOI: 10.17235/reed.2017.4593/2016bogt554l] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. Since there are no accurate serological or radiological available tests, enteroscopy with histopathological examination based on intestinal biopsy specimens is currently the gold standard diagnostic modality of intestinal lymphangiectasia. We report a rare case of a primary intestinal lymphangiectasia in a 60-year-old Caucasian female who presented with asymptomatic hypoalbuminemia and hypogammaglobulinemia. After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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33
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Martins CR, Gagnaire A, Rostain F, Lepage C. Waldmann's disease: a rare cause of protein losing enteropathy in an adult patient. Rev Esp Enferm Dig 2017; 109:385-388. [PMID: 28376626 DOI: 10.17235/reed.2017.4593/2016'||'] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. Since there are no accurate serological or radiological available tests, enteroscopy with histopathological examination based on intestinal biopsy specimens is currently the gold standard diagnostic modality of intestinal lymphangiectasia. We report a rare case of a primary intestinal lymphangiectasia in a 60-year-old Caucasian female who presented with asymptomatic hypoalbuminemia and hypogammaglobulinemia. After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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34
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Martins CR, Gagnaire A, Rostain F, Lepage C. Waldmann's disease: a rare cause of protein losing enteropathy in an adult patient. Rev Esp Enferm Dig 2017; 109:385-388. [PMID: 28376626 DOI: 10.17235/reed.2017.4593/2016'"] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. Since there are no accurate serological or radiological available tests, enteroscopy with histopathological examination based on intestinal biopsy specimens is currently the gold standard diagnostic modality of intestinal lymphangiectasia. We report a rare case of a primary intestinal lymphangiectasia in a 60-year-old Caucasian female who presented with asymptomatic hypoalbuminemia and hypogammaglobulinemia. After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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35
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Martins CR, Gagnaire A, Rostain F, Lepage C. Waldmann's disease: a rare cause of protein losing enteropathy in an adult patient. Rev Esp Enferm Dig 2017; 109:385-388. [PMID: 28376626 DOI: 10.17235/reed.2017.4593/2016%' and 2*3*8=6*8 and 'tzmd'!='tzmd%] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. Since there are no accurate serological or radiological available tests, enteroscopy with histopathological examination based on intestinal biopsy specimens is currently the gold standard diagnostic modality of intestinal lymphangiectasia. We report a rare case of a primary intestinal lymphangiectasia in a 60-year-old Caucasian female who presented with asymptomatic hypoalbuminemia and hypogammaglobulinemia. After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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36
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Martins CR, Gagnaire A, Rostain F, Lepage C. Waldmann's disease: a rare cause of protein losing enteropathy in an adult patient. Rev Esp Enferm Dig 2017; 109:385-388. [PMID: 28376626 DOI: 10.17235/reed.2017.4593/2016����%2527%2522\'\"] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. Since there are no accurate serological or radiological available tests, enteroscopy with histopathological examination based on intestinal biopsy specimens is currently the gold standard diagnostic modality of intestinal lymphangiectasia. We report a rare case of a primary intestinal lymphangiectasia in a 60-year-old Caucasian female who presented with asymptomatic hypoalbuminemia and hypogammaglobulinemia. After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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Patuzzo G, Tinazzi E, Micheletti M, Puccetti A, Lunardi C. Secondary hypogammaglobulinemia in Waldmann's disease treated with subcutaneous immunoglobulins. Eur Ann Allergy Clin Immunol 2016; 48:55-57. [PMID: 26934740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary intestinal lymphangiectasia (PIL) is rare disorder characterized by congenital malformation or obstruction of intestinal lymphatic drainage; it is responsible for protein losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL management. The administration of intravenous immunoglobulins does not always lead to satisfactory plasma levels and therefore the replacement therapy with immunoglobulins is controversial. We describe here the case of a patient with PIL and severe hypogammaglobulinemia treated with immunoglobulins. The striking aspect of this case is the clinical and serological benefit obtained with the subcutaneous compared to the intravenous immunoglobulins administration.
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Affiliation(s)
- G Patuzzo
- Clinical Immunology and Allergy Unit Department of Medicine University of Verona 37134 Verona, Italy. E-mail: Phone: +39 045 812 4401 Fax: +39 045 802 7473
| | - E Tinazzi
- Department of Medicine, University of Verona, Verona, Italy
| | - M Micheletti
- Department of Medicine, University of Verona, Verona, Italy
| | - A Puccetti
- Immunology Area, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - C Lunardi
- Department of Medicine, University of Verona, Verona, Italy
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Abstract
Primary intestinal lymphangiectasia (PIL) is a rare disorder of unknown etiology characterized by diffuse or localized dilation and eventual rupture of the enteric lymphatic vessels in mucosa, submucosa, and/or subserosa. Lymph, rich in all kinds of proteins and lymphocytes, leaks into the gastrointestinal tract via the affected lymphatic vessels causing hypoproteinemia and lymphopenia. The main symptom is variable degrees of pitting edemas of bilateral lower limbs. But edemas of any other parts of body, and mild serous effusions may also occur sometimes. PIL occurs in conjunction with a right hemifacial edema, a right upper limb lymphedema, asymmetric bilateral calves edemas, and a unilateral massive pleural effusion seems never to be reported before. In addition, increased enteric protein loss that may cause severe hypoproteinemia usually get overlooked, and the lymphatic system disorders always put the diagnoses in a dilemma.We described a case of a 17-year-old Chinese girl with a history of gradually progressive swellings of right-sided face, right upper limb, and bilateral calves since 3 to 4 months of age. A right-sided massive pleural effusion, a moderate pericardial effusion, and a mild ascites have been proved unchanged by a series of computerized tomography (CT) scans since 5 years ago. The diagnosis of PIL was finally confirmed by severe hypoproteinemia, endoscopic changes, and histology of jejunum biopsy. Further lymphoscintigraphy and lymphangiography also identified lymph leakage in her bowel and several abnormal lymphatic vessels. A high-protein, low-fat diet supplemented with medium-chain triglycerides (MCT) showed some benefit.This case suggested that PIL was a rare but important etiology of hypoproteinemia, effusions, and edemas. PIL, effusions, and lymphedema can be the features of multisegmental generalized lymphatic dysplasia. In addition, both lymphoscintigraphy and intranodal lymphangiography could be considered when lymphatic system disorders are suspected.
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Affiliation(s)
- Xuefeng Wang
- From the Department of Cardiology, Department of Respiratory Medicine, Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Raithel M, Rau TT, Hagel AF, Albrecht H, Rossi TD, Kirchner T, Hahn EG. Jejunitis and brown bowel syndrome with multifocal carcinogenesis of the small bowel. World J Gastroenterol 2015; 21:10461-10467. [PMID: 26420973 PMCID: PMC4579893 DOI: 10.3748/wjg.v21.i36.10461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/15/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
This is the first report describing a case where prolonged, severe malabsorption from brown bowel syndrome progressed to multifocally spread small bowel adenocarcinoma. This case involves a female patient who was initially diagnosed with chronic jejunitis associated with primary diffuse lymphangiectasia at the age of 26 years. The course of the disease was clinically, endoscopically, and histologically followed for 21 years until her death at the age 47 due to multifocal, metastasizing adenocarcinoma of the small bowel. Multiple lipofuscin deposits (so-called brown bowel syndrome) and severe jejunitis were observed microscopically, and sections of the small bowel showed dense lymphoplasmacytic infiltration of the lamina propria as well as blocked lymphatic vessels. After several decades, multifocal nests of adenocarcinoma cells and extensive, flat, neoplastic mucosal proliferations were found only in the small bowel, along with a loss of the mismatch repair protein MLH1 as a long-term consequence of chronic jejunitis with malabsorption. No evidence was found for hereditary nonpolyposis colon carcinoma syndrome. This article demonstrates for the first time multifocal carcinogenesis in the small bowel in a malabsorption syndrome in an enteritis-dysplasia-carcinoma sequence.
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal-1 waitfor delay '0:0:15' --] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal0'xor(if(now()=sysdate(),sleep(15),0))xor'z] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal" and 2*3*8=6*8 and "7o4f"="7o4f] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal' and 2*3*8=6*8 and 'yp6p'='yp6p] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal-1; waitfor delay '0:0:15' --] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal'||'] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.balvfje7w7k'); waitfor delay '0:0:15' --] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.baliyd4qqop')) or 505=(select 505 from pg_sleep(15))--] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal'"] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal-1); waitfor delay '0:0:15' --] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal%' and 2*3*8=6*8 and 'lroz'!='lroz%] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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