Huge Mesenteric Lymphangioma – A Rare Cause of Acute Abdomen

Abstract

Lymphangiomas are benign congenital masses which occur most commonly in head and neck of children and incidence of mesenteric lymphangiomas is very rare. We report such a case of huge mesenteric lymphangioma in a 20 year old male who presented to us with acute abdomen. Pre-operative diagnosis is difficult due to silent clinical course and lack of awareness of the clinical and morphological features of this disease.

Abdominal lymphangioma

“…3 However, they may come to attention either by abdominal discomfort and palpable lump or by any complication that may occur in it, such as bleed/infection/ rupture or be caused by its effect on adjacent organs, such as volvulus/obstruction. [1][2][3][4] Our case had anemia due to multiple hemorrhages into the cyst, as evidenced by the aspirated fluid, which also lead to abdominal pain. Some may even present with clotting abnormalities due to consumption coagulopathy.…”

“…[1][2][3][4] Drainage and sclerotherapy are employed in select cases where excision is not possible/desirable. [1][2][3][4] The extensive insinuation of lymphangioma into mesentery especially along major vessels, as in our case, makes the dissection without collateral damage challenging. 4 Resection of gut is necessary, occasionally, for comprehensive removal.…”

“…[1][2][3][4] The extensive insinuation of lymphangioma into mesentery especially along major vessels, as in our case, makes the dissection without collateral damage challenging. 4 Resection of gut is necessary, occasionally, for comprehensive removal. 4 The prognosis is excellent when excision is complete.…”

Linfangiomatosis mesentérica

“…El ultrasonido abdominal y la tomografía computada son necesarias para describir los quistes y nos proporciona información importante en la localización, tamaño y si afecta a órganos adyacentes pero no la suficiente información, el diagnóstico de linfangioma en el momento preoperatorio es difícil. 7 El estudio de ultrasonido puede reportar lesiones quísticas bien definidas con múltiples tabiques en el interior o lesiones hipoecogénicas. Por tomografía computada demuestran masas uni-o multiloculares que contienen septos de grosor variable, que con contraste hay refuerzo de la pared.…”

Abdominal Cystic Lymphangioma in Adults: Diagnostic Difficulties and Surgical Outcome

“…The clinical presentations of abdominal cystic lymphangiomas (ACL) are variable and nonspecific and usually not helpful in establishing the diagnosis [3]. Abdominal ultrasonography (US) and computed tomography (CT) are necessary in describing the cyst and providing important information regarding its location, size, and adjacent organs involvement but not sufficient to give an accurate preoperative diagnosis of lymphangioma [4]. Moreover, the differential diagnosis of intra-abdominal cystic lesions is broad and includes besides the cystic lymphangioma other benign and malignant cyst like lesions as pancreatic pseudocyst, cystic teratoma, ovarian cyst, duplication cyst, cystic mesothelioma, malignant mesenchymoma, undifferentiated sarcoma, and adnexal torsion [5].…”