White mesentery and chylous ascites: an interesting presentation of mesenteric lymphangioma

Abstract

We present an interesting and unusual case of a 57-year-old woman presenting with symptoms concerning for a bowel obstruction, and diagnostic imaging concerning for an internal hernia. The patient underwent an emergency laparotomy and was found to have chylous ascites throughout the abdomen, and the extravasation of chyle into the mesentery giving an appearance of a white mesentery. During this case, we will present all of the findings and discuss the unusual underlying pathology.

Interrelation of cancers of unknown primary, chylous ascites, and cavernous mesenteric lymphangioma in a 57-year-old female patient: a case report

“…Chylous ascites or mesentery, stemming from cavernous mesenteric lymphangioma, is a rare occurrence, involving the leakage of thoracic or intestinal lymph into the abdominal cavity. It may result from congenital factors like lymphangiectasia causing vessel dilation, traumatic events leading to lymphoperitoneal fistula formation, or obstructive causes associated with increased intestinal lymphatic system pressure, particularly in the context of lymphatic malignancies [ 4 ].…”

“…Additionally, Chamberlain et al . [ 4 ] are the first to document chylous ascites and mesentery in an adult female with symptoms of intestinal obstruction and suspected internal hernia, with no history of malignancy. Contrastingly, our case has a significantly different history and presentation.…”

“…Typically located in the neck and axilla, lymphangiomas rarely manifest in the small intestine’s mesentery. An exceptionally rare consequence of mesenteric lymphangiomas is the extravasation of abdominal or thoracic lymph fluid into the abdominal cavity, termed chylous ascites [ 4 ].…”