Small bowel lymphangioma causing ileo-ileal intussusception in adults

Abstract

Introduction: Lymphangioma is a rare benign tumor found in gastrointestinal tract. Most lymphangiomas can occur at any age and but mostly are found in children and infants. They are mainly due to malformation of the lymphatic system. They occur mainly in the head, neck and oral cavity, but less commonly develop in the abdominal cavity. Colonoscopy and endoscopic ultrasonography are frequently used to diagnose lymphangiomas of the small bowel. Ileo-ileal intussusception due to small bowel lymphangiomas has been rarely reported.

Presentation of case: We report a case of 24 year old female who presented to the hospital with sudden onset of right sided upper and lower abominal pain with nausea and vomiting, elevated WBC count of 15.1 μL. After careful examination and CT scan of Abdomen patient was found to have an ileo-ileal intussusception secondary to small bowel lymphangioma. In a rare clinical presented case, we performed a diagnostic laparoscopy (Fig. 1), exploratory laparotomy, small bowel resection, and stable primary anastomosis. Post-operative patient did well and was discharged on 4th post-operative day without complications.

Discussion: Lymphangiomas are rare benign tumors which have soft tissue consistency and often congenital malformation of the lymphatic system. Ileo-ileal intussusception in an adults can be a life threatening condition which requires prompt diagnosis and urgent intervention due to the risk of developing ischemic bowel. Prompt diagnosis and urgent intervention can lead to favourable.

Conclusion: We present this rare case of ileo-ileal intussusception secondary to small bowel lymphangioma with literature review.

Keywords: Abdominal pain; Cystic congenital malformation; Ileo-ileal intussusception; Lymphatic system; Small bowel lymphangioma.

Fig. 1

Laparoscopic Findings: Lymph vessels are dilated as seen in the illeal region of the small bowel and also had very rubber type of texture feeling when touched with forceps.

Fig. 2

CT of Abdomen: abnormal loop of small bowel in the pelvis. The presence of mesenteric fat within what appears to be a loop of bowel suggests intussusception.

Fig. 3

Excised Specimen: This gross image shows thinned out wall and dark brown mucosa cover with clotted blood. A broad based polypoid lesion with cyst measuring 1.7 cm in greatest dimension. Also gangrenous portion of intussuscepted small bowel.

Fig. 4

Histopathological findings: arrows are pointing to the area of cystic lymphangioma. irregular cysts with walls composed of smooth muscle cells and fibrocytes, and the inner surface was covered with flat endothelial epithelium, dilated lymphatic lacounae, abundant lymphatic lymphocyte, or lymphoid tissues.