Acute Abdomen for Lymphangioma of the Small Bowel Mesentery: a Case Report and Review of the Literature

PICTURES IN DIGESTIVE PATHOLOGY

Acute abdomen for lymphangioma of the small bowel mesentery: A case report and review of the literature

Mireia Botey, Carlos Muñoz-Ramos, Joan Bonfill, Jordi Roura, Mireia Torres, Sorin Mocanu, Toni Arner, Gumer Pérez, Florenci Salvans and Ángel García-San-Pedro

Department of General and Digestive Surgery. Hospital General de Catalunya. Sant Cugat del Vallés, Barcelona. Spain

CASE REPORT

A 52-years-old patient, without diseases, consulted emergency for a diffuse abdominal pain, diarrhea, and fever of 3 days of evolution. No vomiting or irritating voiding symptoms. The abdomen was tympanic, diffusely painful with defense and signs of peritoneal irritation. Hemodynamically stable. X-ray of the abdomen and thorax and urine sediment were normal. Blood tests without leukocytosis but CRP (C reactive protein) was 5.8 mg/dl (0 to 0.5). The abdominal CT scan detected a cystic mass of 7.2x9.5x7.5 cm, with edematous striation of the root of the mesentery with reactive lymph nodes. There were not signs of ischemic or bowel obstruction or free liquid. It was not suggestive of a mesenteric lymphoma although the first diagnostic option was a mesenteric lymphangioma (Fig. 1). Because of peritonism signs, an emergency laparotomy was carried out. A large cystic mass in the proximal jejunum was found, and an intestinal resection with termino-terminal anastomosis was performed (Fig. 2). The postoperative was favor-

Fig. 1. Abdominal CT scan: Multilocular cystic mass with thin walls with higher density, which measures 7.2x9.5x7.5 cm, with edematous striation of the root of the mesentery and reactive nodes, suggestive of mesenteric lymphangioma. 40 M. BOTEY ET AL. Rev Esp Enferm Dig (Madrid)

Fig. 2. Laparotomy. Multilocular cystic mass in jejunal mesentery root.

able. The biopsy confirmed mesenteric lymphangioma and the immunohistochemistry for D2-40 was positive (Fig. 3).

DISCUSSION

The lymphangioma is a rare benign proliferation of the lymph nodes and it is likely more a congenital malformations than a neoplasm. It is usually localized in the head and neck of the children under 1 year (1,2). Bowel Fig. 3. Biopsy. Hematoxylin-eosin staining and study of D2-40 mesenteric lymphangioma represents less than 1 % of all immunohistochemical positive, diagnosis of mesenteric lymphangioma. lymphangiomas and its clinical presentation is usually as a volvulus or a bowel obstruction (3). For the differential diagnosis is essential the immunohistochemical study of VIII factor antigen, D2-40, calretinina and human melanoma black-45 (HMB-45). Factor VIII and D2-40 in lymphatic malformations are positive, but in multicystic benign mesothelioma are negative. The HMB-45 is positive in lynphangio- mioma (4,5).

REFERENCES

1. Suthiwartnarueput W, Kiatipunsodsai S, Kwankua A, Chaumrattanakul U. Lymphangioma of the small bowell mesentery: A case report and review of the literature. World J Gastroenterol 2012;18:6328-32. 2. Chen CW, Hsu SD, Lin CH, Chemg Mf, Yu JC. Cystic lymphangioma of the jejunal mesentery in an adult: A case report. World J Gastroenterol 2005;11:5084- 96. 3. Rieker RJ, Quentmeier A, Weiss C, Kretzschmar U, Amann K, Mechtersheimer G, et al. Cystic lymphangioma of the small-bowel mesentery: Case report and a review of the literature. Pathol Oncol Res 2000;6:146-8. 4. Campbell WJ, Irwin ST, Biggart JD. Benign lymphangioma of the jejunal mesentery: An unusual cause of small bowel obstruction. Gut 1991;32:1568. 5. Daniel S, Lazarevic B, Attia A. Lymphangioma of the mesentery of the jejunum: Report of a case and brief review of the literature. Am J Gastroenterol 1983;78:726-9.

Rev Esp Enferm Dig 2015; 107 (1): 39-40