Sriram Gonakoti, Zendejas Benjamin, Vargas Sara O, Chen Catherine
Department of Surgery, Boston Children's Hospital, MA, USA.
Department of Pathology, Boston Children's Hospital, MA, USA.
Int J Surg Case Rep. 2017;39:154-158. doi: 10.1016/j.ijscr.2017.07.055. Epub 2017 Aug 5.
Lymphatic malformations are low-flow vascular malformations most commonly located in the head and neck; isolated intraabdominal involvement is rare.
An 8-month-old previously healthy male presented with a 9-day history of fevers. On examination, right-sided abdominal tenderness was noted. Ultrasound revealed a large heterogeneous mass, and CT scan revealed a rim-enhancing cystic mass adjacent to the right colon. Laboratory investigation including blood cultures was normal. His fever resolved with broad-spectrum antibiotics. Diagnostic laparoscopy revealed a large, firm mass arising from the mesentery of the right colon. An open right hemicolectomy with ileocolonic anastomosis was performed. The infant tolerated the procedure well, and he was discharged home on postoperative day four, pathologic examination identified a mesenteric lymphatic malformation with secondary abscess formation.
This atypical presentation of an uncommon entity was instructive in several ways, particularly illustrating the diagnostic pitfalls that can be introduced by superinfection.
淋巴管畸形是最常见于头颈部的低流量血管畸形；孤立的腹腔内受累情况罕见。
一名8个月大、此前健康的男性出现了9天的发热病史。检查时，发现右侧腹部压痛。超声显示一个大的异质性肿块，CT扫描显示右结肠旁有一个边缘强化的囊性肿块。包括血培养在内的实验室检查均正常。他的发热通过广谱抗生素得以缓解。诊断性腹腔镜检查发现一个起源于右结肠系膜的大而坚实的肿块。进行了开放性右半结肠切除术并做了回结肠吻合术。婴儿对手术耐受良好，术后第四天出院，病理检查发现肠系膜淋巴管畸形伴继发性脓肿形成。
这种不常见疾病的非典型表现具有多方面的指导意义，尤其说明了由超级感染可能导致的诊断陷阱。
