Childhood retroperitoneal lymphangioma presenting following minor trauma

Abstract

A healthy 6-year-old boy presented to our department after falling from a slide 1 meter high and landing in a supine position. Though initially alert, he rapidly became unresponsive; pulse was ®liform, and blood pressure was hardly detected by the emergency paramedics at the site. He was given uids and cardiopulmonary resuscitation (CPR) for 30 min with an endotracheal airway in place and arrived at the hospital approximately 50 min following the accident. On admission, the patient was pale and there was marked abdominal distention and the right side of the abdomen was tender. Temperature was 36.58C, pulse 160/min, respiration 45/min, and blood pressure 80/40 mmHg. Medical and surgical history was unremarkable except for excision of a lymphangioma from the right thigh two years before. Chest X-ray revealed a small heart; cervical spine and pelvic radiography were normal. The initial hematocrit was 19%, and 2 units of packed red blood cells were given. The paleness, abdominal distention, and need for ongoing blood transfusion prompted us to perform emergency laparotomy. On preoperative intravenous pyelography performed on the operating table, both kidneys had adequate excretion of contrast material. The bowel loops were displaced to the left abdomen (Fig. 1). Exploration revealed a huge, black-bluish cystic mass in the right retroperitoneum, extending from the right lobe of the liver deep into the pelvic oor and displacing the ascending colon to the left abdomen (Fig. 2). Exploration of the midline, performed to obtain control of the major vessels before approaching the huge lateral lobulated mass, indicated that the aorta and inferior vena cava were normal. The right gutter was opened and the ascending colon detached from the cystic mass; special care was taken not to damage the mesocolon. Macroscopically, the lesion appeared to be a lymphangioma containing a huge amount of serosanguineous uid, which was attached to the iliac vessels and lateral aspect of the inferior vena cava and right paravertebral area. The mass was easily separated by blunt dissection. Excision was performed in toto, and the majority of the uid aspirated. There seemed to be capsular remnants ®rmly attached to the retroperitoneum at the midline, very close to the renal hilus where some di€use oozing was observed. No active source of bleeding was found. A closed drainage system was left in the right retroperitoneal space for 48 h and then removed with no evidence of bleeding. The histological diagnosis was cystic lymphangioma composed of dilated lymphatic spaces surrounded by connective tissue that contained lymphocytes and Injury, Int. J. Care Injured 30 (1999) 380±383