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CORRESPONDENCE
Year : 2022 | Volume
: 55
| Issue : 6 | Page : 238-239
Cystic lymphangioma of the lesser omentum: A rare case of acute abdomen
Fernando Karel Fonseca Sosa, Yurisiel Montero Verdecia
Department of General Surgery, Celia Sánchez Manduley Hospital, Manzanillo, Granma, Cuba
Correspondence Address:
Fernando Karel Fonseca Sosa
Esperanza Street, #73 between Guadalupe and San Javier, Manzanillo, Granma, Postal Code 87510
Cuba
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/fjs.fjs_162_22
Dear Editor,
Cystic lymphangioma (CL), also known as cystic hygroma or lymphatic hamartoma, is defined as a congenital or acquired vascular malformation of the lymphatic vessels that prevents the correct drainage of the lymph into the venous system with subsequent proliferation and dilation of the lymphatic tissue. CL is more frequent in children, which is considered a benign tumor with exceptional onset in adulthood.[1]
There are few reports of lymphangioma arising from the omentum; however, the exact incidence is unknown. The origin from the lesser omentum is extremely rare.[2]
We present a 67-year-old female who presented with generalized abdominal pain which started 2 days prior. The pain had intensified progressively, was constant, without irradiation, and did not relieve with pain medications. She additionally complained of anorexia and nausea.
On physical examination, the patient had tachycardia of 103 bpm. Abdominal examination revealed abdominal distention, decreased bowel sounds, pain on superficial and deep palpation in all quadrants, and slight peritoneal reaction. Laboratory tests showed leukocytosis (18 × 109/l) with neutrophilia (85%). Abdominal ultrasound identified a large multilocular cystic mass that exceeded the transducer limits, with fine septa inside, and without defining organ of origin.
The patient was taken to the operating room with the preoperative diagnosis of abdominal cyst torsion. Urgent exploratory laparotomy, performed by supra-infraumbilical medial incision, identified an multilocular cystic mass measuring 30 cm × 15 cm in size, arising from the lesser omentum and displacing intra-abdominal organs, with a portion into the transcavity of the omentum [Figure 1]a. A small perforation in the cyst was identified, with serosanguinous content leaking into the cavity and irritating the parietal peritoneum. Careful enucleation of the cyst was performed using double ligature of the vascular pedicle without sacrificing the vasculature of the gastric lesser curvature [Figure 1]b. The operative diagnosis was abdominal cyst perforation.
Figure 1: (a) Intraoperative picture showing multilocular cyst with serosanguinous content. (b) Surgical site after resection of the cyst. The black arrow indicates the gap of the lesser omentumPostoperative histological examination described a multilocular cystic mass measuring 28 cm × 12 cm of size with serosanguinous content. Microscopy showed dilated lymphatic spaces lined by uniform and flattened endothelial cells. Pathology confirmed diagnosis of CL. The patient evolved satisfactorily and was discharged on the 7th postoperative day.
Most patients with CL are initially asymptomatic. The clinical picture can occasionally be more disruptive when complications such as torsion, rupture, bleeding, intestinal obstruction, or compression of adjacent organs occur. Their rarity and silent clinical progression are often reasons for difficulty in preoperative diagnosis.[3]
Abdominal ultrasound is the initial modality of choice in suspected cysts. Lymphangiomas are anechoic cysts with posterior acoustic enhancement. Contrast-enhanced computerized tomography and magnetic resonance imaging can add more information regarding the location, size, other organ involvement, and solid components within cysts, which can contribute to preoperative surgical planning.[4]
Various modalities of treatment have been reported in the literature. These include surgical excision by conventional or video laparoscopic surgery, radiation therapy, sclerotherapy, and chemotherapy. Nevertheless, surgical excision by enucleation is considered the treatment of choice for abdominal cystic lymphangiomas.[5]
CL of the lesser omentum is a rare condition in adults, but more exceptional is its clinical presentation as an acute abdomen.
Acknowledgment
We would like to acknowledge Dr. José Antonio Bello Sosa from Baptist Hospital of Miami, USA, for proofreading.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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