Lymphangioma are congenital malformation of lymphatic vessels and 95% of these involve neck and axillary regions. The abdominal cystic lymphangioma is rare tumour of abdomen. The small bowel mesentery is most commonly involved. Most of the patient present with acute symptoms. We describe an atypical case of an abdominal cystic lymphangioma associated with ileal volvulus subsequent intestinal obstruction presenting at casualty level that underwent surgical intervention.A 38-year-male patient presented to our casualty with symptoms of intestinal obstruction like distension of abdomen, 8 episodes of vomiting and pain abdomen since 4 days. At casualty level BP= 110/76 mmHg and respiratory rate 29 cycles per minute were recorded.On ultrasound abdomen there were dilated small bowel loops which were fluid filled, largest measuring 3.4 cm in diameter. Other findings like minimal free fluid in the pelvis and abdomen with cystic mass lesion in the right lumbar region not showing colour flow within and mesenteric lymphadenopathy. Subsequently contrast enhanced CT (computer tomography) scan of the abdomen was performed to see the transition zone and characterise the cystic mass lesion associated with intestinal obstruction. It revealed dilated jejunal and ileal loops [Table/ Fig-1], which were fluid filled with transition zone near the terminal ileum [Table/ Fig-1,2]. There was abrupt luminal narrowing with segment of mural thickening [Table/ Fig-3] and stratification coupled with prominent converging mesenteric vessels [Table/ Fig-4] suggesting volvulus. Other findings were non Enhancing multicystic lesion along the mesenteric border of the bowel loops in the right lumbar region [Table/ Fig-5]. Other findings like mesenteric lymphadenopathy, ascitis [Table/ Fig-6] and cholelithiasis. After compiling these imaging findings we gave the diagnosis of mesenteric lymphangioma presenting as ileal volvulus resulting to small bowel obstruction with reactionary ascitis.Radiology Section
Ileosigmoid knot (ISK) is an unusual and serious condition that is known to pose a diagnostic dilemma due to overlapping features of acute closed-loop intestinal obstruction. Early diagnosis and intervention are of immense importance in this condition because they can prove life threatening with rapid progression to gangrene of both the ileum and sigmoid colon. We report a case of a 27-year-old man who presented 2 days post-appendicectomy procedure with acute abdominal pain, abdominal distention, and hypovolemic shock. Initial evaluation with ultrasonography (USG) and abdominal X-ray was performed, which revealed pleural effusion, ascites, and an ahaustral dilated large bowel loop in the right upper abdomen with convergence in the left lower abdomen. Further imaging with computed tomography revealed closed-loop obstruction of the sigmoid colon with beaked appearance of its afferent and efferent limbs in the pelvis. There was associated whirling or knotting of the ileum around the sigmoid pedicle along with features of mesenteric ischemia. Emergency laparotomy was performed, which revealed ISK with gangrene of the ileal and large bowel loops.
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