Small-bowel lymphangioma with mesenteric cystic extension causing acute obstruction in an adult: a case report

Abstract

Small-bowel lymphangioma is rare in adults and only exceptionally presents with acute obstruction. A 45-year-old man with no previous abdominal surgery presented with sudden severe abdominal pain, nausea, and vomiting. Computed tomography demonstrated a fluid-density pelvic lesion with a single transition point, twisting of adjacent small bowel and mesentery, proximal dilatation, and mesenteric congestion. Emergency laparoscopy identified bowel twisted around a mesenteric cyst and was converted to laparotomy because distension prevented safe reduction. The lesion was inseparable from the mesentery supplying a 20-cm segment, which was resected en bloc. Histology demonstrated D2-40-positive lymphatic channels extending from mucosa to subserosa and communicating with the mesenteric cyst, confirming lymphangioma. Recovery was uncomplicated and the patient was discharged on postoperative day 7. This case highlights lymphatic malformation as a rare pathological lead point for obstruction in a virgin abdomen.