Result of using a biologic collagen implant (Permacol) for mesenteric defect repair after excision of a huge mesenteric lymphangioma in a child

Laparoscopy for evaluating mesenteric lymphangiomatosis: A case report

Background

Lymphangiomatosis is an extremely rare disease with potential soft tissue, bone, and spleen involvement, which can be characterized by lymphangioma. Only a few cases of colon and mesenteric lymphangiomatosis have been reported. We report a case presenting with fatigue, periumbilical pain, and intermittent bloody stools. This patient underwent a series of examinations. Exploratory laparoscopy, in particular, yielded very valuable images and videos for this disease, which can provide evidence for the diagnosis of this disease.

Case summary

The current patient had fatigue, periumbilical pain, and intermittent bloody stools. Colonoscopy indicated numerous variable-sized hyaline cysts in the colon. Submucosal puncture was performed during colonoscopy. The patient was readmitted to the hospital due to periumbilical pain. B-ultrasound and abdominal CT showed multiple hypoechoic nodules in the mesenteric area. Exploratory laparoscopy was performed, and histopathology revealed that D2-40 was positive. Based on auxiliary examination and laparoscopic biopsy, surgeons and pathologists reached the diagnosis of mesenteric lymphangiomatosis.

Conclusion

Clinicians need to comprehensively improve their knowledge of lymphangiomatosis, and the combination of clinical symptoms, histological characteristics, and colonoscopy biopsy findings should be considered to improve lymphangiomatosis diagnosis, thereby reducing misdiagnosis.

Core tip

Colon and mesenteric lymphangiomatosis is an extremely uncommon benign condition of unknown etiology and pathogenesis in adult patients. We report a case of mesenteric lymphangiomatosis in a 37-year-old woman who presented with fatigue, periumbilical pain, and intermittent bloody stools, as well as lesions in the kidney, spleen, and bones. This case provides new insights into the diagnosis and treatment of this disease.

Experience in the diagnosis and treatment of mesenteric lymphangioma in adults: A case report and review of literature

BACKGROUND

Mesenteric lymphangioma (ML) in adults is a very rare disease. We report six hospitalized adult patients with ML in our hospital between January 2013 and July 2018 to investigate the characteristics and prognosis of ML in adults.

CASE SUMMARY

The male-to-female ratio was 3:3, and the median age at diagnosis was 55.2 years. Clinical manifestations varied; however, most were acute cases (5/6). No history of trauma was reported. None (0/6) of the patients were accurately diagnosed with ML in the emergency and outpatient departments. Mesenteric cysts were identified in four patients (66.7%) by abdominal ultrasound and in five patients (83.3%) by computed tomography. ML was postoperatively confirmed by pathology. Most MLs (4/6) were associated with infection of other systems. ML was located in the mesentery of the small intestine (n = 4), ileum (n = 1) and rectum (n = 1). Cyst fluid was clear (n = 4), chylous (n = 1) and bloody (n = 1). Surgical procedures included complete tumor removal and partial intestinal excision (n = 6). Recurrence and adhesive intestinal obstruction were not observed during the 3-12 mo follow-up period.

CONCLUSION

ML in adults is a rare benign acquired disease that can be cured by surgical treatment. Infection may be a cause of ML.