Mesenteric cystic lymphangioma in pediatric patient: A rare intra-abdominal tumor management in rural country case report

Abstract

BACKGROUND: Mesenteric cystic lymphangioma (MCL) is a benign malformation of the lymphatic system. MCL seldomly occurs with a very rare incidence of around 1:250,000. This neoplasm is more common in pediatric patients. Symptoms can appear with various clinical features ranging from asymptomatic abdominal mass to acute abdomen. CASE DESCRIPTION: Here, we report a case of a 4-year-old girl presenting with an intestinal obstruction that presented with bilious vomiting and abdominal pain. Abdominal ultrasonography (USG) showed a cystic mass at umbilical to suprapubic. The mass included a well-defined cystic lesion divided by thin internal septa. Abdominal computed tomography (CT) scan with contrast revealed an intra-abdominal cystic mass, measuring 9.1 × 4.7 × 9.1 cm in dimension, with feeding artery from A. mesenterica superior. The patient underwent explorative laparotomy, mass excision, and jejunal resection (complete surgical resection). Pathological examination confirmed a diagnosis of mesenteric uniloculated cystic lymphangioma. The patient was discharged uneventfully at the 4th post-operative day. MCL should be considered as one of the differential diagnoses in acute abdominal and abdominal mass cases in children. In case of abdominal pain, in the absence of peritonitis, differential diagnosis includes constipation or obstruction due to hernia, intussusception, volvulus, or a tumor. USG and CT are considered as the most appropriate radiodiagnostic modalities to evaluate mesenteric lymphangioma. The diagnosis is made after surgical resection and histological examination. CONCLUSION: MCL is a rare entity, but should be considered as cause of bowel obstruction without other known abdominal disease, complete resection is the treatment of first choice, with low recurrence rate and a non-complicated post-operative period.