Mesenteric neurofibroma in von Recklinghausen's disease

Intestinal obstruction in von Recklinghausen's disease

AIM

Gastrointestinal manifestations occur in up to 25% of patients with neurofibromatosis type 1. This review reports all published cases of acute intestinal obstruction due to neurofibromatosis type 1 and identifies mechanisms of obstruction, the nature of the tumour and the outcome.

METHOD

A systematic review of the literature on acute intestinal obstruction due to neurofibromatosis type 1 was performed by searching the major electronic databases. All relevant references were reviewed for possible inclusion. All the references of the relevant articles were screened for any further articles that were missed in the initial search.

RESULTS

We identified 25 articles from 1972 to 2013 reporting 25 patients with von Recklinghausen's disease who underwent laparotomy for acute intestinal obstruction. Three further patients were operated on in our institution. The mean age of the patients was 44.2 years and the male/female ratio 15/13. The mechanisms of obstruction were intrinsic obstruction (16), extrinsic obstruction (8) and intussusception (4). Histology was reported to show neurofibroma (19), gastrointestinal stromal tumour (5) and adenocarcinoma (4). Among patients whose outcome was mentioned (17), 10 were asymptomatic after a mean follow-up of 1.5 years.

CONCLUSION

Acute bowel obstruction is a rare manifestation of neurofibromatosis type 1. Surgery is often necessary to treat the complication and to determine the exact nature of the tumour and the prognosis.

Mesenteric plexiform neurofibroma in an 11-year-old boy with von Recklinghausen disease

We experienced the case of an 11-year-old boy diagnosed as having type 1 neurofibromatosis with intraabdominal and pelvic masses. On physical examination, there were multiple café-au-lait spots larger than 15 mm in diameter scattered over the patient's entire body and axillary freckling, but no cutaneous neurofibromas were present. Lisch nodules were detected in the iris by a slit lamp. A large, firm mobile mass was palpated in the lower abdomen. Abdominal computed tomographic scan showed the hypodense masses in the lower abdomen and pelvic cavity. At laparotomy, a 16 x 9-cm, firm nodular mass along the mesentery of the terminal ileum and ascending colon was found. The mesenteric mass was encasing the superior mesenteric vessels and extending into the serosa of the intestine. The mass was incompletely excised together with affected intestine. However, resection of the rectum could not be performed because of the extensive involvement of the entire mesorectum. Histopathologic study revealed a plexiform neurofibroma involving the mesentery and intestine without evidence of malignant transformation. The postoperative course was uneventful. Ten months after the operation, a magnetic resonance imaging showed no interval change of the mesorectal mass.

Abdominal migraine in children with neurofibromatosis type 1: a case series and review of gastrointestinal involvement in NF1

BACKGROUND

Symptomatic involvement of the gastrointestinal tract in children with neurofibromatosis type 1 (NF1) is rare. Most reported complications in adults are caused by the presence of neurofibromas in the stomach, small bowel, or mesentery. In contrast, abdominal pain in children with NF1 may be the result of nonanatomic causes, such as migraine. There are no previous reports of an association between abdominal migraine and NF1.

METHODS

Children with abdominal migraine were identified from a group of children with NF1, all of whom had been followed up for a minimum of 3 years. Medical records of cases were reviewed independently by two authors. MEDLINE was searched via PubMed for all reports of children with NF1 and any associated gastrointestinal involvement.

RESULTS

Six children with NF1 and intermittent, episodic, severe abdominal pain are reported. Investigations for obstructive or inflammatory causes of abdominal pain were negative. All patients had previously been diagnosed with migraine headaches by a neurologist. In five of the six patients, propranolol (10-15 mg three times daily) resulted in relief of their abdominal pain within days of starting therapy. Our review identified 24 children in the medical literature with gastrointestinal complications of NF1, mostly secondary to visceral neurofibromas. In almost all of these cases, clinical examination and simple radiologic investigations led to the definitive diagnosis. There were no reports of abdominal migraine complicating NF1.

CONCLUSIONS

Abdominal pain secondary to migraine is an unrecognized cause of abdominal pain in children with NF1 and may be more common than anatomic causes of abdominal pain in children with NF1. In children with NF1 and severe recurrent abdominal pain in whom an evaluation for anatomic lesions is negative, a trial of migraine therapy may be indicated.