Description

In a 82-year-old man with cardiovascular comorbidities underwent an abdominal CT scan, showing an incidental 9 centimeters cystic mesenteric lesion. An additional Magnetic Resonance Imaging (MRI) described a not-enhanced cystic lesion, with septa, developed in the mesenteric root with a mass effect without any sign of bowel invasion (Figure 1). This lesion was not observed in a previous abdominal CT scan. A cystic peritoneal mesothelium was suspected. A surgical treatment was thus indicated. Because of the location at the mesenteric root, an open approach was performed, revealing a cystic mesenteric multi-loculated lesion, with white liquid contain (Figure 2). A bowel resection of proximal jejunum (45 centimeters) was performed with an handsewn end-to-end anastomosis. Pathological analysis identified a cystic mesenteric lymphangioma without any criteria of malignity.

Cystic lymphangioma is a rare benign tumor with ectopic lymphatic vessels, most common in children. Cervico-facial location is the most frequent, in 60% of cases. Profound abdomiabdominal location is rare, between 2 and 10% of cases, with an incidence of 1/100000 adults and 1/20000 children per year [1]. In this location, patients are usually not symptomatic, but the lesion grows considerably and can induce a clinical mass effect. Management of these lesions is based on follow-up, surgical resection [2], or intra-cystic injection of sclerotic drug in the case of unresectable lesions [3]. Recurrence is frequent and depends on the surgical resection.

Figure 1: Axial T2-weighted MRI showing an hyperintense cystic formation (indicated by the star) of 9 centimeters, with intra cystic septa, developed of the mesenteric root, with mass effect without intestinal invasion.

Figure 2: Intraoperative aspect of the cystic lesion (indicated by the star) located at the mesenteric root, at 30 centimeters from the duodeno-jejunal angulation.

Statements and declarations

Conflict of interest disclosure: None.

Funding statement: None.

Ethics approval statement: Not necessary.

Patient consent statement: Yes.

References

1. Chegdali O, Guedira M, Benaddi L, El Idrissi Lamghari A, Lachkar H, et al. Cystic abdominal lymphangioma in adult. Acta Endoscopica. 2004; 34: 245-248.
2. Sana L, Fehd K, Imen R, Faouzi C. Mesenteric cystic lymphangioma. Surgery. 2021; 170: e25-6.
3. Bezzola T, Bühler L, Chardot C, Morel P. Surgical therapy of abdominal cystic lymphangioma in adults and children. Journal of Surgery. 2008; 145: 238-243.