When a lymphatic malformation determines a bowel volvulus: Are clinical status and images always reliable?
Edoardo Guida1, Massimo Di Grazia2, Elisabetta Cattaruzzi3
1Department of Paediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
Introduction:
An acute abdomen in the form of small-bowel volvulus could be a presentation of a lymphatic malformation in childhood.
Case Presentation:
A 5year old male was admitted to our Institute for an acute abdomen. Clinical aspects and radiological images were not specific for a certain diagnosis. Laparotomy revealed a big soft mass, with a milky content, completely involving about 50cm of ileus with a partial volvulus of the intestinal loop. A complete mass excision and also a bowel involved resection were performed. After a histological examination, a lymphatic malformation was diagnosed.
Discussion:
The diagnosis of a mesenteric lymphatic malformation could be intraoperative and a complete resection should be the treatment of choice. Sometimes it could be necessary to perform an involved bowel tract resection in the case of volvolus with ischemia.
Conclusions:
Paediatricians and surgeons should bare in mind that an intrabdominal lymphatic malformation may present as a nonspecific an acute abdomen caused by a bowel volvolus and diagnosis may not be so simple preoperatively.
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