Abdominal pain in a young man revealing an infected perigastric cystic lymphangioma

Abdominal cystic lymphangiomas are a rare pathology of childhood. They are lymphatic malformations that develop in the retroperitoneum or mesenteric space [1] [2]. They are most often asymptomatic and are revealed during an acute complication. When they are symptomatic, surgical resection is the rule [3].

We report the case of a 17-year-old patient with no medical history referred for abdominal pain and fever. Biologically, we only found inflammatory syndrome. The abdominal computed tomography (CT) scan showed a collection under the stomach and above the pancreatic tail. There was a fatty infiltration suggesting inflammatory involvement. Magnetic resonance imaging of the abdomen revealed a lesion measuring 64 × 39 mm of retro-gastric topography. This lesion presented regular sharp contours. There was intense and homogeneous contrast of the shell, with a heterogeneous upper portion that appeared almost adherent to the gastric wall ([Fig. 1]). We performed endoscopic ultrasonography (EUS), which found a retroperitoneal cyst located between the splenic hilum, the left adrenal gland, the left kidney, and the tail of the pancreas. The lesion presented an abscessed appearance with a vascularized wall ([Fig. 2]). There was no intra- or retroperitoneal adenopathy ([Video 1]). Antibiotic therapy was started for 8 days. The diagnosis of an infected retro-gastric cystic lymphangioma was retained. Under antibiotic therapy, the evolution was rapidly favorable, and surgical indication was retained. An abdominal CT scan performed 4 months later showed a reduction of the homogeneous retro-gastric lesion ([Fig. 3]). A laparoscopic resection was performed with monobloc retro-gastric lymph node dissection. The postoperative course was simple and anatomopathological findings confirmed the diagnosis [4] [5].

Fig. 1 Abdominal magnetic resonance imaging showing a retro-gastric cystic lymphangioma. a Cystic lymphangioma located behind the stomach (red arrow) with homogeneous content in T1 sequence. b Cystic lymphangioma located behind the stomach (red arrow) with significant wall enhancement after contrast injection (green arrow).

Fig. 2 Endoscopic ultrasound appearance of cystic lymphangioma with vascularized walls.

Video 1 Endoscopic ultrasound confirming the diagnosis of cystic lymphangioma with argument for infection leading to its surgical resection.

Fig. 3 Abdominal computed tomography scan 4 months after the infectious episode, showing a decrease in size of the retro-gastric cystic lymphangioma (yellow arrow).

Most symptomatic cystic lymphangiomas are revealed by abdominal pain, but no case of infection has ever been described. EUS, in addition to other imaging techniques, allows the diagnosis, especially if the latter are insufficient for diagnosis. Surgical treatment remains the reference for this type of condition.

Endoscopy_UCTN_Code_CCL_1AB_2AG_3AC

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Raufaste Tistet M, Ernst O, Lanchou M. et al. Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas. Abdom Radiol N Y 2020; 45: 3589-3607
• 2 Konen O, Rathaus V, Dlugy E. et al. Childhood abdominal cystic lymphangioma. Pediatr Radiol 2002; 32: 88-94
• 3 Steyaert H, Guitard J, Moscovici J. et al. Abdominal cystic lymphangioma in children: benign lesions that can have a proliferative course. J Pediatr Surg 1996; 31: 677-680
• 4 van Oudheusden TR, Nienhuijs SW, Demeyere TBJ. et al. Giant cystic lymphangioma originating from the lesser curvature of the stomach. World J Gastrointest Surg 2013; 5: 264-267
• 5 Martín-Pérez E, Tejedor D, Brime R. et al. Cystic lymphangioma of the lesser omentum in an adult. Am J Surg 2010; 199: e20-e22

Publication History

Article published online:
15 May 2023