Complete Resection of a Complicated Huge Mesenteric Lymphangioma Guided by Mesenteric Computed Tomography Angiography With Three-Dimensional Reconstruction: Report of a Case

Abstract

We herein describe the case of an adult with a complicated huge lymphangioma of the small bowel mesentery. Computed tomography (CT) confirmed a 45 × 30 × 14 cm multiple and separate, mixed and solid cystic tumor without enhancement by contrast medium in the abdominal cavity. Mesenteric CT angiography with three-dimensional (3D) reconstruction showed that the tumor did not involve the first jejunal artery, although the tumor did involve the subsequent jejunal and ileal arteries and the corresponding segment of the small bowel. Under anatomic guidance based on mesenteric CT angiography with 3D reconstruction, we were able to successfully excise the tumor. Mesenteric lymphangioma should be excised even when the tumor is asymptomatic. Mesenteric CT angiography with 3D reconstruction is useful for the surgical treatment of huge mesenteric tumors.

A Huge Cystic Retroperitoneal Lymphangioma Presenting with Back Pain

“…In some cases they are revealed incidentally during abdominal examination or radiology for another abdominal condition. However, there are several reported cases of lymphangiomas leading to surgical emergencies, such as hemorrhage, bowel obstruction, ureteric obstruction, and sepsis [7, 8, 19, 20]. Lesser sac lymphangioma was reported to mimic acute appendicitis [21].…”

“…Retroperitoneal location being one of the rarest locations accounts for about 1% of all lymphangiomas [6]. Clinical presentation of retroperitoneal lymphangioma is diverse, from asymptomatic to bowel obstruction, sepsis, and disseminated intravascular coagulopathy [7, 8]. Back pain is also a rare clinical presentation of this rare clinical entity.…”

Sonographic findings in two cases of lymphangioma of the mesocolon in adults

“…Mesenteric lymphangioma accounts for less than 1% of all abdominal cases . A literature review shows that all mesenteric lymphangiomas are huge (larger than 5 cm), single, and appear as multilocularcystic masses; thus, conversely, although rare, a mesenteric lymphangioma should be included in the differential diagnosis of such a cystic mass demonstrated in the abdomen . The mesentery is made of connecting folds covered by peritoneum and is divided into the small bowel mesentery (jejunal mesentery and mesoileum) and mesocolon (ascending, transverse, descending, and sigmoid mesocolons and mesoappendix) .…”

“…In symptomatic cases, clinical presentations are diverse, depending on the location and size of the cyst, including pain, fullness, and distension of the abdomen. Acute symptoms frequently occur following the onset of complications, such as intracystic hemorrhage, infection, cyst rupture, or torsion . Cystic lymphangiomas are locally invasive; thus, resection of large mesenteric lymphangiomas is recommended to prevent serious complications.…”

“…Most cases of lymphangioma of the mesentery occur in children, and presentation in adulthood is relatively rare. Although representing less than 1% of all lymphangiomas, the majority of adult cases of mesenteric lymphangioma reported to date have developed from the small bowel mesentery, and there are very few adult cases of mesocolic lymphangioma in the English literature …”