When a lymphatic malformation determines a bowel volvulus: Are clinical status and images always reliable?

Highlights • Small-bowel volvulus could be a presentation of a cystic mesenteric LM. • Diagnosis could be intraoperative. • Complete excision including, in some selected cases, a bowel resection, should be the treatment of choice.
Introduction An acute abdomen in the form of small-bowel volvulus could be a presentation of a lymphatic malformation in childhood. Case presentation A 5 year old male was admitted to our Institute for an acute abdomen. Clinical aspects and radiological images were not specific for a certain diagnosis. Laparotomy revealed a big soft mass, with a milky content, completely involving about 50 cm of ileus with a partial volvulus of the intestinal loop. A complete mass excision and also a bowel involved resection were performed. After a histological examination, a lymphatic malformation was diagnosed. Discussion The diagnosis of a mesenteric lymphatic malformation could be intraoperative and a complete resection should be the treatment of choice. Sometimes it could be necessary to perform an involved bowel tract resection in the case of volvolus with ischemia. Conclusions Paediatricians and surgeons should bare in mind that an intrabdominal lymphatic malformation may present as a nonspecific an acute abdomen caused by a bowel volvolus and diagnosis may not be so simple preoperatively.