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Lymphatic malformation of abdomen in children; eight year experience from a tertiary care centre.

Raashid Hamid*, Reyaz Ahmad, Zahid Akbar, Younis Ahmad, Idress Ahmad, AkshitSudhanshu, Nisar A Bhat, Ajaz Ahmad Baba, Gowhar Nazir Mufti, Khursheed Ahmad Sheikh,Waseem Jan shah

Introduction: Lymphatic malformations of abdomen include mesenteric, omental and retroperitoneal cysts. These are benign malformations with variable presentation. These malformations may present as abdominal distension, abdominal pain, features of intestinal obstruction and rarely acute abdomen. Ultrasonography, CT scan and MRI provide characteristics of malformations like size, composition and may at times help in determining the origin of the lesion. Surgical exploration confirms the diagnosis besides being therapeutic. The mesenteric and omental cysts are either enucleated or need bowel resection or sometimes, partial cyst excision with marsupliazation. Intraoperative injection of the sclerosing agent is an option in instances when excision is not possible or feasible. We analysed the clinical characteristics, management and follow-up of these cases in our study.

Methods: We analysed 26 cases of abdominal lymphatic malformations. The data regarding epidemiological and clinical characteristics were reviewed and recorded. Operative record and imaging findings were noted. The long and short term results of the surgical treatment were analysed.

Results: Twenty six cases (18 Male:8 Female) were included in this study. The most common presentation was chronic abdominal symptoms like pain, vomiting or distension. Three patients had antenatal diagnosis while eleven patients had symptoms three months before being diagnosed. The average age of presentation was 48.64 months. Twelve (46.15%) patients had solitary cyst. Fifteen (57.69%) patients had mesenteric cyst, 6(23.07%) had omental cyst and five (19.23%) patients had cyst extending to the retro peritoneum. Twelve patients underwent enucleation. Serous fluid was the content in ten (38.48%) patients. Two patients needed emergency surgery for intestinal obstruction. The average follow-up was 46 months. Two patients required re-exploration after initial incomplete resection. Overall recurrence rate was seen in four cases (15.38%).

Conclusion: Lymphatic malformations of abdomen can have varied presentation. Ultrasonography and CT scan or MRI is useful diagnostic tools. Mesenteric cysts need resection anastomosis. Omental cysts are amenable to resection. Multi-loculated and retroperitoneal cyst may need partial excision or sclerotherapy. Long term outcome is excellent.