An acute presentation of pediatric mesenteric lymphangioma: a case report and literature overview

• Published in: Acta chirurgica belgica Vol. 118; no. 5; pp. 331 - 335
• Main Authors: Clement, Céline, Snoekx, Rob, Ceulemans, Pieter, Wyn, Inez, Matheï, Jan
• Format: Journal Article
• Language: English
• Published: England 01-10-2018
• Subjects: Biopsy, Needle; Child, Preschool; Digestive System Surgical Procedures - methods; Emergency Service, Hospital; Follow-Up Studies; Humans; Immunohistochemistry; Laparotomy - methods; Lymphangioma - diagnostic imaging; Lymphangioma - pathology; Lymphangioma - surgery; Male; Mesentery - pathology; Mesentery - surgery; Neoplasm Invasiveness - pathology; Neoplasm Staging; Peritoneal Neoplasms - diagnostic imaging; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery; Rare Diseases; Risk Assessment; Tomography, X-Ray Computed - methods; Treatment Outcome; Ultrasonography, Doppler - methods; Mesenteric lymphangioma; emergency; pediatric surgery; lymphangioma; children; surgery
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2017.1379802

Lymphangioma accounts for 5% of benign pediatric tumors and less than 1% is located in the abdomen. While mesenteric lymphatic malformation or mesenteric lymphangioma (ML), mostly appears asymptomatic in adults, an acute clinical presentation is seen more often in children. Symptoms can mimic obstruction or peritonitis and diagnosis can therefore be challenging. Imaging studies are performed to exclude other causes of obstruction or peritonitis. Diagnosis of ML is always made by histology. Surgery is the treatment of choice and recurrence after complete resection is rare.
We describe an acute abdomen in a four-year-old boy caused by a mesenteric lymphatic malformation. Imaging studies at the emergency department were inconclusive and final diagnosis was made by histological examination. Surgical intervention with resection of an ischemic ileal segment was necessary. Complete resection of the ML was not possible without compromising the functional digestive outcome due to diffusely spread lesions in the mesentery of the small bowel. Follow-up with ultrasound was performed.
Mesenteric lymphangioma can cause an acute abdomen in children. Complete resection is recommended but might not be feasible without compromising the functional digestive outcome. Alternative treatments should be studied further to treat diffuse and complicated ML.