Letters to the Editor

Indian Pediatrics 1999; 36:617-619

Lymphangietasia of Small Intestine

Lymphangiectasia, characterized by dilated and proliferating lymphatic channels, is a benign lesion. Though regarded as malformation, the precise nature of this lesion whether hamartomatous or neoplastic is uncertain(I,2). Overall the majority of these lesions are present in childhood and the commonest sites are head, neck and axilla with fewer cases occurring in parenchymal organs(1,2). Involvement of intra-abdominal organs is quite rare, constituting 1.6% of all cases(3,4). The most common, intra-abdominal location is the mesentry followed by omentum, mesocolon and retroperitoneum. Small intestinal involvement is extremely rare(5). A case of localized small intestinal lymphangiectasia is being reported for its rarity.

A four-year-old male child presented with pain abdomen, fever and vomiting for one day. Abdominal examination revealed guarding and tenderness all over the abdomen and bowel sounds were absent. Radiographic examination revealed multiple fluid levels in the abdomen. Preoperative diagnosis of acute appendicitis was considered. However, exploratory laparotomy revealed the presence of an oblong cyst measuring 12 X 13 cm on 'antemesentric border of ileum about 60 cm from ileocaecal junction. Resection of cyst alongwith ileal segment was done and end to end anastomosis performed. The post-operative period was uneventful.

Gross examination showed a circum- scribed oblong cystic mass on the antemesentric border of small intestine. Cut surface showed multiple small cystic areas filled with white gelatinous material. Light microscopic examination revealed multiple cystic ally dilated anastomosing channels lined by a flattened endothelium (Fig. 1) ex- tending from submucosa to serosa of small intestine, intersecting and insinuating the layers of the wall of the intestine.

 

In this particular case, significant amount of capillaries and adipose tissue intermixed with lymphatic channels pointed to a hamartomatous nature. These lesions are benign and malignant transformation though reported is exceedingly rare(6).
 

Rajni Kaushik,
Shayam L. Kaushik*,
Jaishree Sharma,
B.B. Sharma,
Departments of Pathology
and Pediatrics; *
Indira Gandhi Medical College,
Shimla, Himachal Pradesh,
India.
 

References