Emergency presentation of cystic lymphangioma of the colon: A case report and literature review

Lymphatic malformation (LM) in the abdomen is uncommon in children, and the standard treatment is surgical excision. The present study aimed to evaluate the safety and efficacy of laparoscopic surgery of intra-abdominal LM in a pediatric population. The medical records of 10 children with intra-abdominal LM treated by laparoscopic resection from March 2017 to June 2021 in The Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) were retrospectively reviewed. Equal numbers of female and male patients were included and underwent surgery at the median age of 55 months (range, 40 days-94 months). Abdominal pain was the most frequent symptom presenting in eight patients (80%). All children were referral patients, and half of them presented to the emergency department with acute abdominal pain. All 10 of the patients benefited from laparoscopic treatment; three patients underwent extraperitoneal segmental intestinal resection and anastomosis via an enlarged umbilical incision, and two patients were converted to laparotomy because of a large retroperitoneal LM with involvement of the colon. No recurrence or complications occurred in the patients during the follow-up period with mean of 35 months (range, 11-60 months) after surgery. Overall, laparoscopic resection of intra-abdominal LM was an effective, minimally invasive therapy in the pediatric population. Segmental intestinal resection is usually required to achieve the complete removal of lesions to lessen the risk for recurrence.

/pdf/laparoscopic-surgery-of-intra-abdominal-lymphatic-3aoszl0b.pdf

Laparoscopic surgery of intra-abdominal lymphatic malformation in children

Lymphangioma is a rare, benign lesion derived from a malformation of the lymphatic system, which is more frequently found in the head, neck, and axilla. However, it may be present anywhere in the body, and the diagnosis involves adults as children with some distinct clinical features among them. In pediatric patients, abdominal cystic lymphangioma occurs mostly in the mesentery presenting abdominal pain, intestinal obstruction, or, more rarely, hemorrhage. The authors report the case of a child with a short-course history of fever, abdominal pain, and constipation. The physical examination disclosed the presence of an abdominal mass and signs of peritoneal irritation. Imaging was consistent with a cystic lesion compressing the sigmoid colon and laterally displacing the remaining loops. Exploratory laparotomy was undertaken, and a sigmoidectomy, followed by Hartman's colostomy, was performed. Histological examination revealed the nature of the lesion as a cystic lymphangioma. The authors highlight the clinical features of this entity and call attention to this disease in the differential diagnosis of acute abdomen or abdominal pain, mainly in pediatric patients.

/pdf/subserous-lymphangioma-of-the-sigmoid-colon-an-uncommon-4lcb2picei.pdf

Subserous lymphangioma of the sigmoid colon: an uncommon cause of acute abdomen in pediatric patients

Background Cystic lymphangiomas are rare benign tumours and their actual incidence in the colon is unclear. Within the large bowel, these lesions are often submucosal and are incidental findings on colonoscopy. Case report A 43-year-old man with colonic lymphangioma presented with a 7-month history of abdominal pain and altered bowel habits. Computed tomography showed a cystic mass lesion at the distal descending colon. Colonoscopy revealed a smooth, polypoid mass, initially thought as an inverting diverticulum. He underwent laparoscopic high anterior resection. The pathological analysis revealed the descending colon mass to be a lymphangioma with no evidence of diverticulosis. Conclusion There is increasing incidence in lymphangioma due to the increasing accessibility to colonoscopy, particularly for asymptomatic or subacute disease. Although colonoscopic excision, sclerotherapy and use of steroids or fibrin glue have been advocated as possible modes of treatment, surgical excision is still considered to be the treatment of choice.

Colonic lymphangioma presenting with intermittent pain and intussusception.

The present study reports the case of a 79-year-old Chinese man who presented to The First Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) for the treatment of lower gastrointestinal bleeding. Multiple cystic masses in the sigmoid colon were observed with colonoscopy, and through endoscopic ultrasound (EUS), these cystic masses were confirmed to be echo-free and to exhibit septal walls in the submucosal layer; in consequence, lymphangiomatosis of the sigmoid colon was diagnosed. Considering the repeated bleeding, laparoscopy-assisted partial sigmoid colon resection was performed. The excised specimens were multiple vesicular and soft masses of ~1 cm in diameter, which were located in the submucosal layer and were surrounded by flat endothelial cells. Immunohistochemistry revealed that the specimens were positive for the specific lymphatic endothelial marker D2-40. The pathological diagnosis was consistent with the EUS findings. In the 2-year follow-up after the operation, no bleeding or other complications were noticed.

https://www.spandidos-publications.com/10.3892/ol.2016.5399/download

Lymphangiomatosis of the sigmoid colon - a rare cause of lower gastrointestinal bleeding: A case report and review of the literature.

Colonic lymphangioma is an unusual benign malformation. We herein describe two cases. A 36-year-old woman was admitted with one year of intermittent abdominal pain; colonoscopy, abdominopelvic computed tomography and endoscopic ultrasonography (EUS) revealed enlarged cystic masses at the ascending colon. In another 40-year-old man, colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon. Both patients underwent laparoscopic segmental colectomy. Both masses were histologically confirmed as cystic lymphangiomas, and the patients were discharged without complications. The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complication risks. Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive, minimally invasive intervention with a fast postoperative recovery.

Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option

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Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option