Chylolymphatic Cyst Research Articles

Chylolymphatic cyst as a rare cause of acute intestinal obstruction in infants

BackgroundChylolymphatic cysts are benign pathology in lymphatic vessels due to obstruction in the lymphatic system. Their incidence is still unknown. However, they account for approximately 3 to 9% of all pediatric lymphangiomas. Most of these lesions are asymptomatic and are discovered accidentally. They can be presented with nonspecific abdominal pain, vomiting, and changes in bowel habits. Rarely, chylolymphatic cysts can as intestinal obstruction, volvulus or even torsion.Case presentationA 3-month-old male presented to our unit with manifestations of acute intestinal obstruction. Abdominal examination revealed signs of generalized peritonitis and intestinal obstruction. Abdominal ultrasound revealed minimal turbid intraperitoneal collections and no motility of bowel loops. Plain erect abdominal radiograph revealed multiple small bowel air fluid levels. Abdominal exploration revealed a large chylolymphatic cyst causing acute intestinal obstruction. Excision of the cysts was done with preservation of adjacent bowel loop. The patient was discharged in good health on the 6th day postoperative. A chylolymphatic cyst with a diameter of 5 cm was identified by histological investigation.ConclusionsMost chylolymphatic cysts in infants are asymptomatic, but they can cause fatal complications such as intestinal obstruction, volvulus, or even torsion.

A giant chylolymphatic cyst of the retroperitoneum: a case report

Abstract Chylolymphatic cysts are an extremely rare variant of mesenteric cysts and account for 7.3% of all abdominal cysts. They can develop anywhere along the mesentery of the gastrointestinal tract and present in a wide range of symptoms. A 46-year-old male presented with mild abdominal pain and intermittent claudication in his right leg for the last 2 months and a history of a retroperitoneal resection of a simple abdominal cyst 5 years ago. Abdominal ultrasound and computerized tomography showed a fluid-filled cystic lesion measuring 17 × 11 × 10 cm in the right retroperitoneum. The cyst was surgically excised, and the histopathological examination was consistent with the chylolymphatic cyst. On a 1-year follow-up, the patient is recovered with no recurrence observed. Our report presents a case of a giant retroperitoneal chylolymphatic cyst with uncommon presenting symptoms and a rare etiology.

Chylolymphatic cyst of abdomen in a toddler: a rare case report

Cystic lesion of abdomen in a toddler is a rare condition. It can be developmental, infectious, benign or malignant in nature. The site of origin may be from intrabdominal organs, omentum, mesentery, retroperitoneum, vasculature and lymphatics. They often present as acute abdominal pain, abdominal distension or constipation. Radiology and histopathology helps to arrive at diagnosis. We report a rare case of chylolymphatic mesenteric cyst in a 2 year old male child diagnosed by histopathology.

Chylolymphatic Cyst - Presenting as Acute Intestinal Obstruction – A Case Report

Chylolymphatic cyst is one of the rare variants of mesenteric cysts. These cysts are present within mesentery and contain chylous or lymphatic fluid. Chylolymphatic cysts are rare in paediatric age group. We present a case of a four years old boy who presented with features of acute intestinal obstruction. CECT abdomen revealed a hypodense cystic mass in the peritoneal cavity. Exploratory laparotomy of the abdomen revealed a solitary cyst measuring 10.7 cm x 9.4 cm x 10.5 cm which was adherent to the loops of small intestine and right kidney. Complete excision of cyst along with resection of the adjacent gut and end to end anastomosis was done. Histopathology of the excised cyst was suggestive of chylolymphatic cyst. It has been highlighted that chylolymphatic cyst can be a rare cause of intestinal obstruction in children.

Chylo-lymphatic mesenteric cyst in a 7-year-old

Mesenteric cysts are rare intra-abdominal masses that usually remain asymptomatic and present incidentally on radiological imaging. As the incidence is low, with paucity of data, careful pre-operative assessment and execution of surgical procedure often present a challenge to the treating clinician. A 7-year-old female child presented with gradual distention of abdomen and dull abdominal ache. On clinical examination, a huge mass measuring 1812 cm was detected in the lower abdomen. On radiological imaging, a diagnosis of mesenteric cyst was made. Intra-operative findings were consistent with mesenteric cyst, and complete surgical excision was carried out by laparotomy. The histopathology report revealed a chylo-lymphatic type of mesenteric cyst. Huge, benign abdominal masses in pediatric patient may represent mesenteric cysts, and the diagnosis can be confirmed by radiological imaging modalities such as abdominal contrast-enhanced computed tomography. Complete surgical removal of the cyst remains the treatment of choice, as the literature is against marsupialization or aspiration of cyst owing to a higher chance of infection and morbidity.

Management outcomes of mesenteric cysts in paediatric age group.

Background:Mesenteric cysts are rare intra-abdominal masses and high index of suspicion is required to clinically suspect this pathology and make a definitive diagnosis. They are most commonly located in the ileal mesentery but can be located anywhere along the gastrointestinal tract mesentery and may extend into the retroperitoneum. The rarity of these anomalies and diversity of clinical picture pose challenges in the diagnosis and operative management. The objective of this study is to determine the demographic pattern, clinicopathological diagnosis and management outcome of mesenteric cysts in our hospital.Materials and Methods:This retrospective study was conducted on children operated for mesenteric cysts from October 2013 to September 2020. Statistical analysis was performed using Open Epi Version 3.01.Results:Out of 32 children with a diagnosis of mesenteric cyst, 78% were below 5 years of age. Small intestine was affected in 26 cases and large bowel mesentery was the site of origin in six cases. Complete excision of mesenteric cyst was possible in all cases. Bowel resection was required in ten cases (31%) to enable complete excision. Bowel resection was required more often in children operated on emergency than those with elective surgery, and is statistically significant (P = 0.04; confidence interval: 0.05–0.96, odds ratio: 0.23). An uncommon co-existence with ileal atresia and detection of rare chylolymphatic cyst in another infant were also remarkable findings. Histopathology proved the diagnosis in all cases. There was no mortality or recurrence during hospitalisation and follow-up, which ranged from 3 months to 3 years.Conclusions:Mesenteric cysts present with diverse clinical features and children below 5 years of age are most commonly affected. Complete surgical excision is the optimal treatment and may require bowel resection in significant number of cases, especially those operated during emergency. Histopathology is the gold standard for diagnosis.

Chylolymphatic Cysts in Children: A Rare Condition

Objective: To find out the clinical findings, anatomical types and preferred operative treatment for paediatric chylolymphatic cysts. Study Design: Prospective study Place and Duration of Study: Department of Pediatric Surgery/General Surgery Bahawal Victoria Hospital, Bahawalpur and Department of Pediatric Surgery/General Surgery Unit-ll, DHQ Teaching Hospital, Dera Ghazi Khan from 1st January 2018 to 31st December 2020 Methodology: Fifteen patients of either gender with age from 18 months to 8 years (96 months) enrolled. Clinical data of all the patients diagnosed as chylolymphatic cyst on exploration was recorded. Results: There were 8 (53.3%) females and 7 (46.7%) males with mean age was 49.80±27.07 (months). Four patients (26.66%) presented with abdominal mass, 5 patients (33.33%) presented with abdominal pain, 1 patient (6.66%) with abdominal mass and pain while 5 patients (33.33%) presented with signs of intestinal obstruction. Three (20%) had cysts at multiple sites, i.e., mesentery of jejunum, ileum and mesentery of sigmoid colon, 5 (33.33%) patients had cysts in jejunal mesentery while 9 (53.33%) patients’ cyst was found in ileal mesentery and 1 (6.66%) had cyst in mesentery of cecum. Fourteen underwent exploratory laparotomy and 1 was managed laparoscopically. Post-operative recovery in 14 patients was uneventful and 1 patient managed by open surgery underwent respiratory complications and later expired. No recurrence was noted during follow up period up to 6 months. Conclusion: Surgical exploration and surgical excision and sometimes resection anastomosis of gut is mainstay of treatment with excellent results. Key words: Paediatric mass abdomen, Mesenteric cysts, Chylolymphatic cyst, Paediatric surgery

Pediatric chylolymphatic mesenteric cyst: A rare entity

Mesenteric cysts are uncommon cystic lesions with variable clinical presentations. These are infrequently encountered lesions reported both in children and in adults. Chylolymphatic cysts are rare variants of mesenteric lesions and constitute 7.3%–9.5% of all abdominal cysts. Very few cases of pediatric chylolymphatic cysts have been reported in the literature. Herein, we report a case of chylolymphatic cyst in a 1½-month-old child, which is a rare entity.

Case report: Left sided gall bladder associated with chylolymphatic cyst of mesentery of small intestine

Mesenteric cyst and left sided gall bladder both are rare entity. Incidence of mesenteric cyst is 1 per 1,00,000 to 2,50,000, a rare abdominal tumor, among which chylolymphatic mesenteric cyst is further rare. In left sided gall bladder, gall bladder is attached on left lateral sector of liver, left to falciform ligament and interlobar fissure. Left sided gall bladder can be a single anomaly or associated with other anomalies like duplicated gall bladder, hypoplastic bile duct, situs inversus, anomalous pancreatico-biliary ductal junction, absence of quadrate lobe, accessory liver. In our case it was associated with mesenteric cyst which is the first case to be reported to best of our knowledge.

Pediatric abdominal chylolymphatic cysts: Sneaky abdominal masqueraders.

Chylolymphatic mesenteric cysts of the abdomen is a rare differential for cystic tumors, more so in the pediatric age group, and they have various clinical presentations. There have been very few cases reported worldwide. To the best of our knowledge, a multicystic chylolymphatic cyst of the abdomen as demonstrated below is the first reported occurrence worldwide in the pediatric age group. We herein report the case of a 1-year-old who presented to us with gradual distension of the abdomen for 4 months with occasional episodes of vomiting and a lobulated cystic abdominal mass on palpation. He was mistakenly treated with anti-tuberculous treatment for suspected loculated ascites. The imaging revealed a multiloculated mass in the abdomen in close relation to the small bowel. He was also worked up for tuberculosis, and the findings were negative. Laparotomy revealed multiple cysts closely applied to the jejunum, starting at 4 cm from the duodenojejunal flexure, which was resected and anastomosed. To the best of our knowledge, this is the first reported case of an abdominal chylolymphatic cyst occurring as a chain of multiple cysts in the pediatric age group, and we want to emphasize the importance of further imaging in a case of suspected loculated tuberculous ascites as this is a differential diagnosis with a treatable surgical option. Surgical excision of these cysts should be done in toto as an individual excision of each of these cysts in an attempt to preserve the bowel length may end up jeopardizing the blood supply of the affected bowel.

Pediatric Chylo Lymphatic Mesentric Cyst

Chylolymphatic cysts are rare variants of mesenteric lesions constituting 7.3% to 9.5% of all abdominal cysts displaying variable presentation and having surgical implications in the pediatric age group. The preoperative imaging studies are suggestive however histopathological examination remains the gold standard for diagnosis. A two months old male child was admitted with complaints of bilious vomiting for three days which was initially nonbilious in nature. There were no other significant medical or surgical complaints. X ray abdomen showed evidence of intestinal obstruction.Ultrasound revealed a large cystic lesion in abdominal cavity with internal echos arising from the ileal mesentery on ultrasonography. Subsequently exploratory laparotomy with excision of ileal segment involved by cyst and ileoileal anastomosis was performed and cyst was sent for histopathological examination. On syringing milky white fluid was aspirated which on biochemical analysis confirmed the chylous nature. The histopathological examination revealed an unilocular cyst having a fibrous wall infiltrated by lymphocytes and macrophages and lined by single layer of flattened epithelium with few dilated lymphatic channels consistent with chylolymphatic cyst. Although vary rare, chylomesenteric cyst should be kept as one of the differential diagnosis of cystic masses of the abdomen.

Surgical management of congenital chylous ascites

Objective: The objective of this study was to present our experience regarding the diagnosis and therapeutic approach in cases of congenital chylous ascites that were surgically managed in our department in a 10-year period. Background: Congenital chylous ascites is a rare condition that constitutes a challenge for physicians. This condition is often refractory to therapy, and it is responsible for serious malnutrition and immunological deficiency because of losses of proteins and lymphocytes. Patients and methods: From 2007 to 2017, four cases of congenital chylous ascites were managed at our center. All cases were treated surgically after failure of medical treatment. Results: The first patient had no definite lymphatic leaks rather than presence of a moderate amount of milky ascitic fluid with dilated lymphatics at the root of the mesentery and at the intestinal wall and enlarged regional lymph nodes. The second one had leaking chylolymphatic cyst in the greater omentum that was excised. The third patient had no definite lymphatic leaks rather than thickened greater omentum, and thus, subtotal omentectomy was done. The fourth baby had no definite lymphatic leaks and developed reaccumulation of the ascitic fluid 1 month after surgery; insertion of a peritoneovenous shunt was indicated that succeeded to resolve the ascites. All children are growing up normally with no recurrence of the ascites on long-term follow-up. Keywords: chylolymphatic cyst, chylous ascites, lymphatic leak, peritonealvenous shunt

Surgical management for mesenteric cysts in pediatric patients: a single center experience

Background: Mesenteric cysts are exceptional abdominal lesions of childhood. Presentation may vary with broad spectrum of symptoms from asymptomatic mass and nonspecific complaints to an acute abdomen. Objectives of this study were to present a series of patients with mesenteric cysts and to analyze our experience with emphasis on the presentation, management, and outcome.Methods: This observational study included thirteen children were diagnosed and treated for mesenteric cysts. All cases subjected to clinical evaluation, laboratory investigations and radiological studies. The diagnosis was confirmed on laparotomy. Ethics committee approval was obtained. The main data which extracted and analyzed included demographic data, operative finding, postoperative complications and duration of hospital stay. Data were analyzed using SPSS for Windows software and P value of ≤ 0.05 was considered significant.Results: There were 13 patients with mesenteric cyst, 5 girls and 8 boys. The ages ranged from neonate to 8 years. Abdominal mass and pain was the main presenting symptoms. Prenatal diagnosis established in two cases. Laparotomy performed in all cases. Small bowel mesentery is the commonest site. Two patients required urgent surgery. Surgical procedures included cyst excision with or without intestinal resection. Chylolymphatic cyst was documented in 4 cases. Post-operative complications reported in 2 cases.Conclusions: Mesenteric cysts are unusual in children with variable clinical presentation. Complete excision was feasible in nearly all cases, bringing a favorable outcome. The possibility of this disease entity should be considered as the cause of acute abdomen.

Giant abdominal chylolymphatic cyst: Review of two rare cases

Giant abdominal chylolymphatic cyst: Review of two rare cases

Case series of unusual causes intestinal obstruction in infants and children

Introduction Many of the causes of intestinal obstruction arise from congenital anomalies that can present at any time from infancy to adulthood. Other frequent causes of intestinal obstruction in pediatric population results from complicated external hernias, intussusceptions, volvulus, or bands of adhesions. Patients and methods We report seven unusual cases presented with symptoms and signs of acute intestinal obstruction in infants and children, which necessitated surgical intervention. Radiological investigation showed signs of intestinal obstruction. Results On exploration, rare causes of intestinal obstruction were found. In the first patient, congenital mesenteric defect was the cause of obstruction. The second patient had unusual entrapment of a loop of bowel in the ileocecal recess. In the third patient, non-Hodgkin’s lymphoma was the leading point for intussesception. In the fourth patient, a large multiloculated chylolymphatic cyst was found. In the fifth, sixth, and seventh patients, a rare presentation of remnants of ophalomesentric duct was identified. In the eighth patient, a large polyp of Peutz–Jeghers syndrome was found to obstruct the lumen of the jejunum, and it was the nidus for jejunojejunal intussesception. All of the previously mentioned causes of obstruction are rarely observed in children. Conclusion Management of these conditions requires ahigh degree of suspicion, careful assessment, and awareness while the appropriate treatment needs to be tailored to the individual situation. Keywords : childhood period, intestinal obstruction, unusual presentations

A giant chylolymphatic cyst presenting as intestinal obstruction in a neonate

We are reporting a case of giant chylolymphatic cyst of mesentery that presented with obstruction in a neonate. On exploratory laparotomy surgical excision of the cyst along with ileum was carried out. The cyst was diagnosed as chylolymphatic cyst on histopathological examination. Due to rarity, we are prompted to report this case.

Chylolymphatic cyst of the greater omentum presenting as abdominoscrotal swelling in a child

Omental cyst are rare abdominal lesions and are difficult to diagnose. They are detected incidentally during imaging studies performed for unrelated reasons. In children, it may present as an acute abdomen due to intestinal obstruction or painless abdominal swelling. Imaging is helpful in excluding other causes of lump abdomen. We encountered a case of giant omental cyst presenting with abdominoscrotal swelling in a child. The patient underwent laparotomy and the diagnosis of omental cyst was established by intraoperative findings. Thus complete excision of the cyst was performed. The diagnosis was confirmed by pathological examination.