Experience of primary intestinal lymphangiectasia in adults: Twelve case series from a tertiary referral hospital

Abstract

BACKGROUND While primary intestinal lymphangiectasia (PIL) is considered a rare condition, there have been several reported cases in adults. Nevertheless, the absence of clear guidance from diagnosis to treatment and prognosis poses challenges for both physicians and patients. AIM To enhance understanding by investigating clinical presentation, diagnosis, treatment, complications, and prognoses in adult PIL cases. METHODS We enrolled adult patients diagnosed with PIL between March 2016 and September 2021. The primary outcome involved examining the diagnosis and treatment process of these patients. The secondary outcomes included identifying complications (infections, thromboembolism) and assessing prognoses (frequency of hospitalization and mortality) during the follow-up period. RESULTS Among the 12 included patients, peripheral edema (100%) and diarrhea (75%) were the main presenting complaints. Laboratory tests showed that all the patients exhibited symptoms of hypoalbuminemia and hypogammaglobulinemia. Radiologically, the predominant findings were edema of the small intestine (67%) and ascites (58%). The typical endoscopic finding with a snowflake appearance was observed in 75% of patients. Among the 12 patients, two responded positively to octreotide and sirolimus, and eight who could undergo maintenance therapy discontinued subsequently. Complications due to PIL led to infection in half of the patients, thromboembolism in three patients, and one death. CONCLUSION PIL can be diagnosed in adults across various age groups, with different severity and treatment responses among patients, leading to diverse complications and prognoses. Consequently, tailored treatments will be necessary. We anticipate that our findings will contribute to the management of PIL, an etiology of protein-losing enteropathy.

Intestinal lymphangiectasia: Understanding the bigger picture

“…Diagnosis is confirmed through histopathological examination of mucosa showing dilated lacteals. It is crucial to highlight the absence of parasites or villous atrophy in biopsies[ 2 ]. It is important to consider that sporadic detection of IL during endoscopy does not always indicate a sinister condition.…”

“…Of great interest is a recent article by Na et al [ 2 ] on adult primary intestinal lymphangiectasia (PIL) that provides insight into its clinical features, varied complications, treatment response, and prognosis. PIL is characterised by dilatation of intestinal lymphatics and eventual rupture, which can have multiple consequences.…”