Ex Utero Intrapartum Treatment (Exit) of Gigantic Intrapartum Lymphangioma and Its Management Dilemma - A Case Report

Abstract

With the advancement of radiological investigation, intrapartum detection of fetal abnormalities is now precisely performed. Lymphangiomas are now diagnosed even before patient is born. The swelling may be gigantic and potentially life-threatening during the delivery. Nowadays, it is still a great challenge to doctors as how to deliver the baby together with the big neck mass. We present a case of huge intrapartum neck lymphangioma, for which we performed ex-utero intrapartum treatment (EXIT) procedure, followed by excision of the lesion later. The challenges on managing both mother and infant will be discussed.

Intubación endotraqueal intraparto en fetos con obstrucción de la vía aérea. Dos primeros casos de cirugía EXIT en el Hospital Rebagliati – EsSalud

“…La edad gestacional media de término de gestación en las revisiones sistemáticas es de 35 semanas, debido a la alta incidencia de rotura prematura de membranas o parto pretérmino que se produce debido al polihidramnios secundario, como ocurrió en el caso 1 y que limitó el estudio por resonancia. Se debe evitar las cirugías de urgencia, por la necesidad de implementar adecuadamente la organización del procedimiento (8)(9)(10) .…”

Feeding and Swallowing Trends in Infants Born via Exit Procedure for Giant Head and Neck Masses

“…In these cases, an ex-utero intrapartum treatment procedure (EXIT) is utilized for safe delivery of these infants [2]. To date, there has been published data on medical-surgical management of giant masses [2,4,5]; however, minimal to no data regarding swallowing abilities and outcomes has been published on this unique population. Feeding-swallowing is a complex task requiring infants to coordinate sucking, swallowing, and breathing.…”

Intralesional Bleomycin Sclerotherapy of Lymphangiomas in Children: Our Initial Experience

“…As needed, dermoscopy and biopsy can be used to confirm the diagnosis, and imaging may be warranted to assess the depth and extent of the lesion (4). As most congenital lymphangiomas can now be diagnosed during intrapartum with advanced radiological techniques, EXIT (ex utero intrapartum treatment) is one of the treatment options with improved maternal and fetal outcomes (5). On clinical examination, these lesions appear soft, compressible, nontender, transluminant and without any bruit (6).…”