Primary intestinal lymphangiectasia: Multiple detector computed tomography findings after direct lymphangiography

Duodenal-Acquired Intestinal Lymphangiectasia After Lymph Node Excision and Inferior Vena Cava Injury in an 18-Year-Old Woman

Intestinal lymphangiectasia (IL) is a rare disorder characterized by dilation and obstruction of the small bowel lymphatic ducts, resulting in malabsorptive diarrhea and edema. While the majority of IL is congenital and presents in infancy, secondary acquired IL rarely presents as a long-term sequela after abdominal or pelvic surgeries. We report an 18-year-old woman who underwent surgical resection of ovarian cancer with subsequent endoscopic and histologic evidence of duodenal IL. This case highlights the importance of increased endoscopic awareness for iatrogenic acquired IL in clinical practice.

Visible Lymph Affluents in the D3 Volume: An MDCTA Pictorial Essay

BACKGROUND

There seems to be a gap in knowledge of the anatomy of mesenteric lymphatics between the superior mesenteric nodes and the intestinal trunk. To our knowledge, these central lymph vessels were not hitherto systematically searched for, described, or morphometrically analyzed. Our aim was to identify those vessels on the routine multidetector computerized tomography angiography (MDCTA), performed prior to right colectomy for cancer, with extended mesenterectomy, central vascular ligation, and D3 lymphadenectomy.

METHODS

A total of 420 MDCTA datasets were analyzed utilizing manual segmentation and 3D reconstruction, with the aid of image processing software Osirix, Mimics, and 3-matic. The 3D models and masks underwent a detailed topographic and morphometric analysis.

RESULTS

Significant vascular-like structures, having neither origin nor termination on the blood vessels, were noted in 18 cases (4.3%) in the D3 volume. The dimensions of visible lymph vessels varied, their mean diameter was 1.81 ± 0.61 mm, and the mean length was 38.07 ± 22.19 mm. In the vast majority of cases, the lymph vessels were situated in front of the superior mesenteric artery (SMA), coursing either longitudinally cranially (13 cases) or transversely/obliquely to the left (5 cases). In all cases but one, the lymph vessel passed at the left-hand side of the middle colic artery. As for the course shape, in seven cases, the lymph vessel appeared highly serpiginous.

CONCLUSIONS

The regular MDCTA can provide valuable information on mesenteric lymphatics and aid in surgical planning.