LINFAGIOMA QUÍSTICO DE EPIPLÓN COMO CAUSA DE ABDOMEN AGUDO PEDIÁTRICO. ACTUALIZACIÓN DEL TRATAMIENTO: REPORTE DE CASO.

Abstract

Introduction Mesenteric lymphagioma is a rare, benign, congenital cystic tumor of the lymphatic vessels, which occurs in 2-5% of cases at the abdominal level (75% cervical, 20% axillary), which occurs more frequently during the childhood. It occurs with an incidence of 1: 250,000 during childhood (60% cases before one year of age), the ratio of women to men is 2: 1. They are located mainly in the subperitoneal space, in the mesentery (59% - 68%), omentum (20% - 27%) and retroperitoneum (12% - 14%). This should be suspected as a differential diagnosis of acute abdomen and pediatric abdominal masses. Its complete excision with negative microscopic margins is the treatment of choice, either by conventional means by exploratory laparotomy or by other less invasive techniques such as laparoscopy. Case description A 6-year-old boy presented with abdominal pain and peritonism. Physical exam: positive rebound sign. Paraclinical: leukocytosis, neutrophilia. Ultrasound shows abundant free fluid in the abdomen and pelvis. Patient undergoes an exploratory laparotomy, finding a multicystic mass dependent on the greater omentum, a sample of peritoneal fluid is taken for cytochemical, bacteriological, culture and histopathology. Complete excision of the cyst plus partial omentectomy and incidental appendectomy is performed. Patient with favorable evolution tolerates diet at 24 hours with progression from liquid to soft, undergoes antibiotic treatment for 48 days based on cefazolin (suspended due to negative culture at 48 hours and negative BARR), with hospital discharge on the fourth day. Result of fibrin-filled peritoneal fluid, transudate and negative histopathology for malignancy. Histopathology report: Macroscopic: irregular tissue fragment measuring 10 x 6 cm, greyish-yellow, cystic areas measuring 1.5 and 4 cm; When cut, it drains mucinous material, the rest of the irregular yellowish areas. Microscopic: fibrofatty tissue with congestive vessels and mixed inflammatory infiltrate (lymphocytes and polymorphonuclear cells), compatible with cystic lymphagioma (Fig. 3). Immunohistochemistry positive for marker D 2-40. Patient with follow-up at 7 days; In months 1, 3, 6 and year with favorable evolution, a control ultrasound was performed at the sixth month and at one year without evidence of recurrence. Conclusion: Mesenteric cystic lymphagioma can present with symptoms of acute abdomen. Complete resection is the treatment of choice, minimally invasive procedures are currently performed with favorable results in children, ultrasound is sufficient for long-term follow-up.