Solitary Intestinal Lymphangiectasia Causing Transient Intussusception

Abstract

Lymphangiectasia is the benign malformation of lymphatic channels associated with either focal or diffuse dilation of vessels and impaired lymph drainage. This malformation has the potential to create a cystic mass due to the accumulation of lymphatic fluid. While rare in adults, intussusception, the telescoping of the proximal bowel into the distal bowel, can be caused by a mass within the bowel. In this case, a near-obstructing cystic colon mass developed in a 74-year-old man; this was later found to be a large lymphangiectasia. In addition, this near-obstructing colonic lymphangiectasia served as the lead point in a colo-colonic intussusception. Due to this complication, the mass was immediately removed by a laparoscopic oncologic right-extended hemicolectomy which proved to be both diagnostic and therapeutic.

Keywords: bowel obstruction; intussusception; lymph; lymphangiectasia; lymphatic malformation; lymphatics; colonoscopy.

Figure 1. Axial CT showing colocolic intussusception and an ovoid hypodense mass measuring 4.7 x 3.8 cm transaxial by 4.8 cm craniocaudal is seen within the intussusception.

Figure 2. Coronal CT showing colocolic intussusception and an ovoid hypodense mass measuring 4.7 x 3.8 cm transaxial by 4.8 cm craniocaudal is seen within the intussusception.

Figure 3. Right upper quadrant abdominal ultrasound showing a 2.5 x 4.7 cm irregular fluid collection near the gallbladder fossa

Figure 4. A. Colonoscopic images showing a soft, smooth, polypoid cystic lesion with a broad base. Blood represents the site of biopsy. B. Similar view with dark fluid representing endoscopic tattooing.

Figure 5. Pathology gross image showing fluid-filled right colon mass during laparoscopic right hemicolectomy

Figure 6. Pathology histological slide showing normal gastrointestinal mucosa (white arrow) and submucosal cyst wall of lymphangiectasia (black arrow)