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Pediatric abdominal lymphangiomas: a plea for early recognition
M A Kosir1, R E Sonnino, M W Gauderer
1Department of Surgery, Rainbow Babies and Childrens Hospital, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, OH.
Insights
Abdominal lymphangiomas, distinct from mesenteric cysts, often cause symptoms like pain and vomiting in children. Early diagnosis via imaging is crucial for effective treatment and preventing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Abdominal lymphangiomas are often misclassified with mesenteric cysts.
- Distinguishing them is vital due to differences in location, histology, and recurrence potential.
Observation:
- A 16-year study identified 13 pediatric abdominal lymphangiomas, with 12 symptomatic cases.
- Common symptoms included abdominal pain, vomiting, and increased abdominal girth.
- Abdominal masses were palpable in 10 patients, with 2 experiencing intestinal gangrene.
Findings:
- Ultrasonography and computed tomography (CT) were the most reliable diagnostic tools.
- Complete resection was not achieved in 2 cases, and 1 recurrence was noted.
- Contrary to literature, these lesions frequently present with significant symptoms.
Implications:
- Prompt diagnosis and surgical excision of smaller lesions can prevent severe complications.
- Ultrasound and CT should be utilized for children with unexplained abdominal pain for early detection.
- Recognizing abdominal lymphangiomas as a distinct entity improves patient outcomes.
Abstract:
Abdominal lymphangiomas are usually classified together with mesenteric cysts. However, they differ by location, histology, and potential for recurrence, and should be considered a separate clinical entity. Thirteen children, aged 2 weeks to 11 years (mean, 5.8 years), with abdominal lymphangiomas were identified over the past 16 years at this institution. Of these, 12 were symptomatic. Abdominal pain (11), vomiting (8), increased abdominal girth (8), and nausea (6) predominated. Other presentations were less frequent. Symptoms were present for an average of 2 months (7 less than 1 week) before correct diagnosis. An abdominal mass was palpable in 10 cases. Intestinal gangrene secondary to volvulus was present in 2. Although multiple imaging modalities were used ultrasonography (8/8) and computed tomography (CT; 4/4) proved most expedient and reliable. In 2 cases, the lymphangioma could not be completely resected. There was 1 recurrence. Although intraabdominal cystic lesions are described in the literature as relatively symptom-free, our experience suggests otherwise. In this series, abdominal pain and an abdominal mass were common. Catastrophic complications can occur and excision is facilitated by earlier diagnosis and the benefit of smaller size. Ultrasound and CT can accurately diagnose the lesion and should be used liberally in children with intermittent or ill-defined abdominal pain, leading to prompt recognition and definitive treatment.
