Open Access, Peer-reviewed
pISSN 2234-8646
eISSN 2234-8840
    Korean J Pediatr Gastroenterol Nutr. 2010 Mar;13(1):86-91. Korean.
    Published online Mar 31, 2010.
    https://doi.org/10.5223/kjpgn.2010.13.1.86
    Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
    Case Report

    A Case of a Retroperitoneal Cystic Lymphangioma Treated by Percutaneous Catheter Drainage and Sclerotherapy

    Hyun Sik Kang, M.D.,* Seung Hyung Kim, M.D.,† Bong Soo Kim, M.D.,† and Ki Soo Kang, M.D.*,‡
      • *Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea.
      • †Department of Radiology, Jeju National University School of Medicine, Jeju, Korea.
      • ‡Institute of Medical Science, Jeju National University, Jeju, Korea.
    • Responsible author (Email: kskang@cheju.ac.kr )
    Received January 31, 2010; Accepted March 07, 2010.

    Abstract

    Retroperitoneal cystic lymphangiomas are benign, extremely rare tumors. Although surgical resection is the treatment of choice, sclerotherapy should be considered initially. A 9-year-old boy was admitted due do worsening abdominal pain of 4 days duration. Serial complete blood counts revealed a hemoglobin level of 12.8 g/dL on admission to 10.6 g/dL on hospital day 3. An abdominal computed tomography (CT) scan showed a large, lobulated, septated, retroperitoneal cystic mass (10×9.5×5 cm) in the left anterior pararenal space with intracystic hemorrhage surrounding the inferior mesenteric vein (IMV). Because of the high operative risk, we performed a tubogram of the cystic mass, percutaneous catheter drainage (PCD), and ethanol sclerotherapy. The follow-up abdominal CT scan showed that the cystic mass had decreased in size. He is well without relapse of the retroperitoneal cystic mass for 13 months after discharge. Sclerotherapy with PCD should be considered as initial therapy for patients with retroperitoneal cystic lymphangiomas at high surgical risk.

    Keywords
    Retroperitoneal cystic lymphangioma; Sclerotherapy

    Figures

    Fig. 1
    On admission, an abdominal CT scan showed a large, lobulated, septated, retroperitoneal cystic mass (10×9.5×5 cm [arrowheads]) in the left anterior pararenal space with intracystic hemorrhage (*) surrounding the inferior mesenteric vein (IMV [small arrow]).

    Fig. 2
    On hospital day 3, a T2-weighted MR scan showed the cystic mass had increased in size with hemorrhage. The hemoglobin level had changed to 10.5 g/dL.

    Fig. 3
    On hospital day 6, a tubogram was performed. The contrast media leaked out to the left paracolic gutters.

    Fig. 4
    On hospital day 15, a second tubogram showed no contrast leakage and the hemoglobin was 11 g/dL. Therefore, ethanol sclerotherapy was performed.

    Fig. 5
    Following abdominal CT showed the cystic mass (arrowhead) markedly decreased in size. The cystic mass still was surrounding inferior mesenteric vein (arrow).

    References

      1. Okazaki T, Iwatani S, Yanai T, Kobayashi H, Kato Y, Marusasa T, et al. Treatment of lymphangioma in children: our experience of 128 cases. J Pediatr Surg 2007;42:386–389.
      1. de Perrot M, Rostan O, Morel P, Le Coultre C. Abdominal lymphangioma in adults and children. Br J Surg 1998;85:395–397.
      1. Hancock BJ, St-Vil D, Luks FI, Di Lorenzo M, Blanchard H. Complications of lymphangiomas in children. J Pediatr Surg 1992;27:220–224.
        discussion 4-6.
      1. Steyaert H, Guitard J, Moscovici J, Juricic M, Vaysse P, Juskiewenski S. Abdominal cystic lymphangioma in children: benign lesions that can have a proliferative course. J Pediatr Surg 1996;31:677–680.
      1. Konen O, Rathaus V, Dlugy E, Freud E, Kessler A, Shapiro M, et al. Childhood abdominal cystic lymphangioma. Pediatr Radiol 2002;32:88–94.
      1. Davidson AJ, Hartman DS. Lymphangioma of the retroperitoneum: CT and sonographic characteristic. Radiology 1990;175:507–510.
      1. Roisman I, Manny J, Fields S, Shiloni E. Intra-abdominal lymphangioma. Br J Surg 1989;76:485–489.
      1. Yang DH, Goo HW. Generalized lymphangiomatosis: radiologic findings in three pediatric patients. Korean J Radiol 2006;7:287–291.
      1. Shankar KR, Roche CJ, Carty HM, Turnock RR. Cystic retroperitoneal lymphangioma: treatment by image-guided percutaneous catheter drainage and sclerotherapy. Eur Radiol 2001;11:1021–1023.
      1. Kosumi T, Kubota A, Yonekura T, Yamauchi K. Cystic lymphangioma of Retzius space manifested as acute abdomen. Eur J Pediatr Surg 2006;16:120–122.
      1. Yang DM, Jung DH, Kim H, Kang JH, Kim SH, Kim JH, et al. Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review. Radiographics 2004;24:1353–1365.
      1. Iyer R, Eftekhari F, Varma D, Jaffe N. Cystic retroperitoneal lymphangioma: CT, ultrasound and MR findings. Pediatr Radiol 1993;23:305–306.
      1. de Lagausie P, Bonnard A, Berrebi D, Lepretre O, Statopoulos L, Delarue A, et al. Abdominal lymphangiomas in children: interest of the laparoscopic approach. Surg Endosc 2007;21:1153–1157.
      1. Tran Ngoc N, Tran Xuan N. Cystic hygroma in children: a report of 126 cases. J Pediatr Surg 1974;9:191–195.
      1. Luzzatto C, Midrio P, Tchaprassian Z, Guglielmi M. Sclerosing treatment of lymphangiomas with OK-432. Arch Dis Child 2000;82:316–318.
      1. Park SW, Cha IH, Kim KA, Hong SJ, Park CM, Chung HH. Percutaneous sclerotherapy using acetic acid after failure of alcohol ablation in an intra-abdominal lymphangioma. Cardiovasc Intervent Radiol 2004;27:285–287.
      1. Ozdemir H, Kocakoc E, Bozgeyik Z, Cobanoglu B. Recurrent retroperitoneal cystic lymphangioma. Yonsei Med J 2005;46:715–718.
      1. Fujino A, Moriya Y, Morikawa Y, Hoshino K, Watanabe T, Shimojima N, et al. A role of cytokines in OK-432 injection therapy for cystic lymphangioma: an approach to the mechanism. J Pediatr Surg 2003;38:1806–1809.
      1. Dubois J, Garel L, Abela A, Laberge L, Yazbeck S. Lymphangiomas in children: percutaneous sclerotherapy with an alcoholic solution of zein. Radiology 1997;204:651–654.
      1. Tanaka K, Inomata Y, Utsunomiya H, Uemoto S, Asonuma K, Katayama T, et al. Sclerosing therapy with bleomycin emulsion for lymphangioma in children. Pediatr Surg Int 1990;5:270–273.
      1. Molitch HI, Unger EC, Witte CL, vanSonnenberg E. Percutaneous sclerotherapy of lymphangiomas. Radiology 1995;194:343–347.
    MeSH Terms
    Abdominal Pain
    Blood Cell Count
    Catheters
    Child
    Drainage
    Ethanol
    Follow-Up Studies
    Hemoglobins
    Hemorrhage
    Humans
    Lymphangioma, Cystic
    Mesenteric Veins
    Recurrence
    Retroperitoneal Neoplasms
    Sclerotherapy
    Metrics
    Share
    Figures
    slide
    slide
    slide
    slide
    slide

    1 / 5

    PERMALINK