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INTRA-ABDOMINAL LYMPHANGIOMA
Prashant Tyagi
Sr. Registrar, Dept. of Surgery, SMS Medical College and Hospital, Jaipur.
Primary tumours originating from the leaves of mesentery are very rare. Most of these are benign and cystic. The following is a case report of a patient of intra-abdominal lymphangioma, who presented to us as a case of intestinal obstruction.

CASE REPORT

A 45 year male patient presented to us as an emergency admission with multiple vomitings, massive abdominal distension and constipation since 2 days. His X-ray flat plate abdomen upright view showed multiple air fluid levels. The patient was taken up for emergency surgery. On laparotomy, a large tumour was found lying between stomach and transverse colon. The tumour was of size 35 x 20 cm. It consisted of multiple cystic spaces filled with cloudy fluid. The cysts were of varying sizes from 1 cm to 15 cm. The tumour was comprising the stomach and small intestine. The whole tumour was dissected and removed. Histopathology report confirmed the tumour to be a case of lymphangioma. The patient is alright after 1 year of follow up.

DISCUSSION

Tumours originating between the leaves of mesentery are very rare. In contrast, malignant implants from intra-abdominal or pelvic tumours to mesenteric lymph nodes are relatively common. Primary tumours of mesentery may be cystic or solid. [1] Of these, cystic growths occur more frequently than solid ones in a ratio of 2:1. The majority of the cystic mesenteric tumours are benign. [2] Chylous or lymphatic cysts are the most frequently encountered benign mesenteric masses. These are thought to arise from developmental defects in mesenteric lymphatics creating closed spaces within which fluid accumulates. They may be unilocular or multilocular, have an endothelial lining, contain a grossly cloudy fluid and often grow to an extremely large size. Lymphangioma of the mesentery is apparently a true neoplasm of lymphatics similar to those found in other parts of the body (cystic hygroma). [3] Grossly and histologically, it is often difficult to differentiate this tumour from a chylous cyst. Approximately two thirds of mesenteric tumours are located in the mesentery of small intestine and less frequently in the transverse or sigmoid mesocolon or in the gastrohepatic ligament. [4] The manifestations of mesenteric tumours are dependent upon the size, location and mobility of the growth. Usually the patient presents with sensation of fullness or abdominal pain. Only rarely will the patient present with symptoms of complete intestinal obstruction. Surgical excision is the only treatment for both benign and malignant lesions. Prognosis after adequate excision of cystic tumours of mesentery is excellent.

REFERENCES

  1. Caropreso PR. Mesenteric cysts, a review. Arch Surg 1974; 108 : 242.
  2. Fowler EF. Primary cysts and tumours of small bowel mesentery. Am Surg 1961; 27 : 653.
  3. Kurtz RJ, Heimann TM, et al. Mesenteric retroperitoneal cysts. Am Surg 1986; 203 : 109.
  4. Vanek VW, Phillips AK. Retroperitoneal, mesenteric and omental cysts. Arch Surg 1984; 119 : 838.

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