gms | German Medical Science

Background: Mesenteric cysts are rare findings, especially in children under the age of 10. As one type of these cysts small-bowel mesentery lymphangioma occur in only 1 % of cases with lymphangioma. The majority of these tumors however, are localized in head or neck areas. We treated three patients matching both criteria: children even under the age of 5 with the histological diagnosis of mesenteric lymphangioma.

Materials and methods: Varying considerably in clinical presentation, sonographic findings and laboratory work we present three girls under the age of 5 with mesenteric lymphangioma from May to September 2015. Every case is documented from time of first encounter, clinical work-up, intra-operative findings to post-treatment care.

Results: The first patient presented with acute abdominal tenderness, periumbilical tenderness on palpation, elevated inflammatory values and unremarkable abdominal ultrasound. The second patient had a history of chronic abdominal pain and constipation for half a year, one episode of urinary retention presenting with strong abdominal pain upon admission. Her laboratory work-up was unremarkable, however sonography showed three large cystic formations in the lower abdomen. The third girl presented with continuous vomiting, leukocytosis and the sonographic finding of a cystic structure in the lower abdomen. In each case the resected tissue was confirmed by histology to be mesenteric lymphangioma.

In two cases we partially resected small bowel, resulting in en bloc removal of the lymphangioma. In one case the cysts were too large and wide-spread to be removed without losing significant bowel tissue. In that case we partially resected the three main cystic formations.

Conclusion: Mesenteric lymphangioma can mimic several abdominal conditions. It should therefore be considered as a rare but significant differential diagnosis to acute appendicitis, ovarian torsion, volvulus and incarcerated meckel´s diverticulum. Due to the difficulty in diagnosis especially in this age group, they pose a significant challenge for treating physicians.