Loading

JSM General Surgery Cases and Images

Adult abdominal cystic lymphangioma revealed by intra peritoneal hemorrhage: A case report

Case Report | Open Access | Volume 5 | Issue 1

  • 1. Department of radiology, Mahmoud El Matri Hospital, Ariana, Tunisia
+ Show More - Show Less
Corresponding Authors
Landolsi Sana,University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia, Phone number: +21698384110
Abstract

Adult abdominal cystic lymphangioma was a very rare none yet elucidated pathology. In our case, it was revealed by intraperitoneal hemorrhage. Complete surgical excision allowed complication treatment and relapse avoiding.

Keywords

• Case report

• Cystic lymphangioma

• Intra peritoneal hemorrhage

Citation

Landolsi S, Youssfi R, Aouida A, Omri A, Ridene I, et al. (2023) Adult abdominal cystic lymphangioma revealed by intra peritoneal hemorrhage: A case report. JSM Gen Surg Cases Images 5(1): 1048.

INTRODUCTION

Adult abdominal cystic lymphangioma was a very rare none yet elucidated pathology. Clinical presentation was variable. Complications were rare but potentially fatal [1].

Herein we present a case of adult abdominal cystic lymphangioma revealed by abdominal pain and anemia secondary to intra peritoneal hemorrhage. The work has been reported in line with SCARE criteria [2]. 

PATIENT AND OBSERVATION

A 24-years old woman with a medical history of chronic anemia thought to be secondary to metrorrhagia, complained about pain in the lower half of the abdomen lasting for one day without other signs. Physical examination revealed a temperature of 38°C with pale conjunctiva, and tenderness in the lower half of the abdomen. Gynecologic exam was normal. Biological exams confirmed an iron deficiency anemia. BetahCG levels were within normal range. After a brief resuscitation, the patient had an exploratory laparoscopy for suspected complicated appendicitis. Peroperative exploration revealed a hemoperitoneum in the Pouch of Douglas (Figure 1) with a 10 cm multicystic lesion arising from small bowel mesentery (Figure 2). No other lesions were associated. Because of the size of the lesion, laparotomy was performed. This lesion corresponded to surface scattered multiple cysts well-encapsulated with thin walls (Figure 3). Total excision was performed with is peristaltic latero-lateral ileo-ileal anastomosis. The postoperative course was uneventful. Histopathological exam revealed a multilocular intra-abdominal cystic lymphangioma with various-sized cystic spaces lined by attenuated endothelial cells arranged in a single layer. No recurrence was noticed after a regular follow up of 12 months.

DISCUSSION

Our case illustrated a complicated extremely rare pathology in adults revealed by abdominal pain associated to misdiagnosed chronic anemia. In fact, adult abdominal cystic lymphangioma accounted for less than 5% of all cystic lymphangiomas [3]. Its etiology is still unknown even though primary lymphatic cysts failure to converge with the main lymphatic system was suggested [4,5]. As in our case, abdominal pain constituted the most revealing symptom [6,7]. Unlike our case, imaging features allowed positive diagnosis with conservative treatment in asymptomatic cases [1]. It presented as a well-defined lesion with anechoic content and fine fibrous separating septa in abdominal ultrasound and as a homogenous hypo dense lesion with nonenhanced contrast walls [8]. Surgical removal was indicated in front of complication as in our case [1]. Laparotomy was preferred for huge lesions [1]. Total resection as performed for our patient reduced relapse in comparison with partial excision [1,9].

CONCLUSION

Adult abdominal cystic lymphangioma still a not fully understood pathology with various presentations. It has to be suspected in presence of evocator aspects. Complications implicate complete excision in order to treat the complication and to avoid recurrence. 

PATIENT CONSENT

A writing informed consent was obtained from the patient to public this report in accordance with the journal’s patient consent policy. 

REFERENCES
  1.  Xiao J, Shao Y, Zhu S, He X. Characteristics of adult abdominal cystic Lymphangioma: a single-center Chinese cohort of 12 cases. BMC Gastroenterology. 2020; 20: 244.
  2. Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler A, Orgill DP, SCARE Group. The SCARE 2018 Statement: Updating Consensus Surgical Case Report (SCARE) Guidelines. Int J Surg. 2018; 60: 132-136.
  3. Kosir MA, Sonnino RE, Gauderer MW. Pediatric abdominal lymphangiomas: a plea for early recognition. J Pediatr Surg. 1991; 26: 1309-1313.
  4. Weeda VB, Booij KA, Aronson DC. Mesenteric cystic lymphangioma: a congenital and an acquired anomaly? Two cases and a review of the literature. J Pediatr Surg. 2008; 43: 1206-1208.
  5. Goh BK, Tan YM, Ong HS, Chan WH, Yap CK, Wong WK. Endoscopic ultrasound diagnosis and laparoscopic excision of an omental lymphangioma. J Laparoendosc Adv Surg Tech A. 2005; 15: 630-633.
  6. Makni A, Chebbi F, Fetirich F, Ksantini R, Bedioui H, Jouini M, et al. Surgical management of intra-abdominal cystic lymphangioma. Report of 20 cases. World J Surg. 2012; 36: 1037-1043.
  7. Tarcoveanu E, Moldovanu R, Bradea C, Vlad N, Ciobanu D, Vasilescu A, et al. Laparoscopic treatment of Intraabdominal cystic Lymphangioma. Chirurgia (Bucur). 2016; 111: 236-241.
  8. Verdin V, Seydel B, Detry O, Daele DV, Meunier P, Honore P, et al. [Clinical case of the month. Cystic lymphangioma of the mesentery]. Rev Med Liege. 2010; 65: 615-618.
  9. Kim SH, Kim HY, Lee C, Min HS, Jung SE. Clinical features of mesenteric lymphatic malformation in children. J Pediatr Surg. 2016; 51: 582– 587.

 Landolsi S, Youssfi R, Aouida A, Omri A, Ridene I, et al. (2023) Adult abdominal cystic lymphangioma revealed by intra peritoneal hemorrhage: A case report. JSM Gen Surg Cases Images 5(1): 1048.

Received : 17 Feb 2023
Accepted : 22 Mar 2023
Published : 24 Mar 2023
Journals
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X