Is laparoscopic cholecystectomy safe for lymphangioma of the gallbladder? A complicated case mimicking subhepatic abscess

Abstract

Lymphangiomas are rare benign neoplasms of the lymphatic tissue generally occurring in the childhood. Cystic lymphangioma of the gallbladder is an extremely rare tumor with only eight cases having been reported in the literature. The aspecific and potentially misleading clinical presentation of these tumors requires complex preoperative imaging in the setting of clinical suspicion to make the correct diagnosis. The treatment of choice is complete excision with negative margins to avoid local recurrence. Their tendency to locally invade the surrounding tissues requires sometimes extended resections. Laparoscopic cholecystectomy can be a questionable choice in this setting; however, the procedures can be performed safely in most cases, although complicated. We report the case of a hemorrhagic cystic lymphangioma of the gallbladder mimicking a subhepatic abscess and operated in emergency with laparoscopic approach.

Lymphangioma of the Gallbladder in Adults: Review of the Literature and a Case Report

“…[5][6][7][8][9][10][11][12][13] Eight cases come from East Asia, 5-8,10-12 one from Europe, 13 and one from North America. 9 Our case is the 11th published, and the second in North America.…”

“…At the time of diagnosis, five patients had gallbladder associated symptoms such as right upper quadrant abdominal pain, nausea, or vomiting, 6,[8][9][10]13 but five patients were asymptomatic and lymphangiomas were discovered incidentally during evaluation of unrelated conditions. 5,7,8,11,12 Two patients with intense acute pain were found to have intracystic hemorrhage.…”

“…7,13 Three patients had concurrent microlithiasis (sludge) in the bile duct, 10 asymptomatic cholelithiasis, 12 and acute cholecystitis. 13 In addition to US and CT, in majority of the cases, the preoperative evaluation included MRI, magnetic resonance cholangio-pancreatography (MRCP), endoscopic retrograde cholangio-pancreatography (ERCP), 5,7-12 and in one case abdominal angiography. 5 Nine of the 10 patients, as well as ours, had a radiologic diagnosis of a cystic mass originating from the gallbladder fossa, and five of those were suspected of being a lymphangioma.…”

“…7,8,11,12 In one instance, the preoperative diagnosis was acute acalculous cholecystitis complicated by a subhepatic abscess. 13 All 10 cases were treated surgically (six open 5-7,9,11,12 and four laparoscopic 8,10,13 ). The time interval from onset of symptoms or incidental diagnosis to surgery ranged from 2 days to 6 years.…”

“…To date, there are 10 published cases worldwide, including only one case from the USA. [5][6][7][8][9][10][11][12][13] They are often asymptomatic and discovered incidentally. If symptoms are present, they are non-specific and associated with biliary pathology.…”