Small bowel lymphangioma causing ileo-ileal intussusception in adults

A Case of Colonic Intussusception Caused by Cecal Lymphangioma and Requiring Emergency Surgery

Lymphangiomas are benign tumors of dilated lymphatic vessels often found in the head, neck, and axilla of children. Lymphangiomas rarely occur in the abdomen, much less in the colon of adults. Colonic lymphangioma can cause symptoms and signs such as abdominal pain and abdominal distension and complications of gastrointestinal bleeding and intussusception. Intussusceptions are rarer in adults than in children. Most cases of intussusception in adults have a distinct cause, and a substantial number are related to malignant tumors. Herein, we report a rare case of ileocecal intussusception caused by cecal lymphangioma that required emergency surgery. A 40-year-old woman presented with severe abdominal pain of a two-day duration. Her abdomen was tender and showed muscle rigidity in the right lower quadrant. Contrast-enhanced CT of the abdomen revealed ileocecal intussusception and a cystic mass, which was the leading point, with no evidence of bowel strangulation. The patient underwent emergency laparoscopic surgery because she had severe abdominal pain and showed peritoneal irritation signs. During surgery, the cecum was found to have invaginated into the ascending colon, almost to the hepatic flexure. Laparoscopic ileocecal resection with central vascular ligation was performed without intraoperative reduction of the intussusception because the cystic lesion could have a malignant component. Upon inspection, the lesion was a 60 mm × 50 mm submucosal mass located in the cecum. It was filled with clear serous fluid and thin walls. Pathology revealed the cystic mass to be a cecal lymphangioma with no evidence of malignancy. The patient was discharged seven days after emergency surgery with no complications. Our case adds to evidence that cecal lymphangiomas can cause colonic intussusception in adults. Although rare, the risk of colonic intussusception must be considered in the management of colonic lymphangiomas.

Lymphangiomatosis presented with melena and chylous ascites: A case report

INTRODUCTION

Lymphangioma, a rare benign tumor of the lymphatic system, is called lymphangiomatosis when it involves >1 organ, which is more rarely complicated with thoracic obstruction, the relationship between them remains unclear. With the development of enteroscopy, clinicians know more about small intestinal lymphangioma and attempt to treat it through enteroscopic injection sclerotherapy(EIS).

PATIENT CONCERNS

A 59-year-old male firstly manifested with gastrointestinal bleeding after a gastric perforation, who was diagnosed with lymphangiomatosis by balloon-assisted enteroscopy and abdomen CT showing >1 organ with multiple cysts besides the small intestine. The patient received an EIS, then the melena disappeared. Surprisingly he came back because of refractory ascites confirmed to be chylous by chemical tests 7 months later.

DIAGNOSIS

Lymphangiography could not determine the location of lymphatic leakage, Ultrasonography showed stenosis of the left cervical part of the thoracic duct.

INTERVENTION

On the condition that medical treatment is ineffective, thoracic duct exploration and lysis of fibrous adhesion were performed.

OUTCOMES

Ascites significantly reduced at last.

LESSONS

Lymphangiomatosis is the malformation of the lymphatic system involving multiple organs, it has a possibility to be associated with thoracic obstruction. Capsule endoscopy and enteroscopy are effective methods to diagnose small intestinal lymphangioma, and EIS is an effective therapy.

Case Report: Endoscopic manifestations and clinical features of small intestinal lymphangioma-A report of two cases

Objective

The aims of this study were to analyze the clinical characteristics, auxiliary examinations, and treatment measures of small intestinal lymphangioma and to improve the clinical diagnostic ability of clinicians.

Methods

This paper reports two cases of small intestinal lymphangioma in the Department of Gastroenterology, the First Affiliated Hospital of Soochow University, and makes a comprehensive analysis.

Results

A 31-year-old woman went to the hospital with complaints of dizziness, fatigue, and anemia. A 52-year-old woman complained of upper abdominal pain and went to the hospital with abdominal pain awaiting investigation. Both patients were subjected to three major routine examinations, tumor complete set, CT, capsule endoscopy, and deep enteroscopy, and both of them underwent complete resection of the affected intestinal segment. Pathology showed that both patients had small intestinal lymphangioma.

Conclusions

The clinical manifestations of small intestinal lymphangioma lack specificity. Capsule endoscopy and deep enteroscopy are helpful for clinical diagnosis, and pathological examination is still the gold standard. Surgical treatment can achieve better results.

Case report: Submucosal cavernous lymphangioma causing jejuno-jejunal intussusception in an adult

Cavernous lymphangioma often occurs in the head, neck, trunk, and extremities of infants and children, and it is rare to cause a small intestine intussusception in adults. In this case, a 32-year-old woman presented with abdominal pain, vomiting, and a 5 cm × 5 cm abdominal mass on the left side of the abdomen. Laboratory tests showed anemia and CT showed small intestinal intussusception. After conservative treatments, her symptoms disappeared. However, 18F-FDG PET/CT suggested malignancy and her symptoms reappeared after eating something. Segmental jejunal resection was performed and pathology showed submucosal cavernous lymphangioma. At the 1-year follow-up, the patient was asymptomatic. Then this paper reviewed the literature on small intestinal cavernous lymphangioma in adults and found that this is the first English case report of intussusception caused by a jejunal submucosal cavernous lymphangioma in an adult. Current problem is that adult intussusception and intestinal lymphangioma are difficult to diagnose preoperatively. Imaging techniques such as tomography and PET/CT aid in the diagnosis of these benign lesions. Surgical resection was considered to be the required treatment and seems to have had no recurrence in adults according to the literature.

A case report of recurrent intussusception caused by small bowel lymphangioma in an adult

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Lymphangioma is a benign tumor that rarely arises in gastrointestinal tract.

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Small bowel lymphangioma can cause intussusception in adults.

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The symptoms of small bowel intussusception in adults resemble those of adhesive small bowel obstruction.

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Reduction is not sufficient and surgical resection of affected bowel should be performed.

Introduction

Adult intussusception and lymphangioma in gastrointestinal tract are uncommon entities respectively. Recurrent intussusception due to lymphangioma of the small intestine is extremely rare and mimics adhesive small bowel obstruction (SBO).

Presentation of case

A 37 year old man presented with acute abdominal pain and vomiting. He had been admitted several times for adhesive SBO after laparoscopic cholecystectomy at age 21. He was initially managed with a long tube placement, with which he used to get well. This time, the symptoms once relieved but soon relapsed, so an exploratory laparotomy was performed. Intraabdominal adhesiolysis was performed alongside the excision of a small segment of damaged jejunum. Intussusception of jejunum was noted and its reduction was also performed. Unfortunately, the symptoms continued after the operation, and computed tomography revealed a recurred intussusception of the jejunum. A reoperation with an additional resection of small intestine surrounding intussusception was performed. The symptoms subsided after the second operation and the patient was discharged. Pathological examination revealed lymphangioma within the affected lumen.

Discussion

Intussusception in an adult is often caused by a tumor but can be caused by postoperative adhesion. The reduction is a potential option of treatment if there is no tumor suspected, but sometimes it would be uneasy to affirm the non-existence of tumors.

Conclusion

We present this rare case of recurrent jejuno-jejunal intussusception caused by small bowel lymphangioma with review of literature. Taking the possibility of recurrence and malignancy into account, the resection should always be considered in such patients.