Ann Surg Treat Res.  2018 Jan;94(1):52-56. 10.4174/astr.2018.94.1.52.

Surgery of multiple lymphangioma in small bowel: a rare case report of chronic gastrointestinal bleeding

• Lim DR
• Kuk JC
• Kim T
• Shin EJ

• KMID: 2405340
• DOI: http://doi.org/10.4174/astr.2018.94.1.52

Abstract

Small bowel lymphangioma is a rare benign tumor of the lymphatic system, characterized by the presence of dilated lymphatic spaces and significant gastrointestinal bleeding. Small bowel lymphangiomas are rare in adults and case reports are few. Lymphangiomas in the jejunum or ileum are extremely rare and account for less than 1% of all lymphangiomas. The case reported herein is of an older patient (70-year-old male) with melena and chronic anemia (hemoglobin count < 5 g/dL) who had small-sized multiple lymphangiomas in his small bowel (jejunum). Surgical resection was performed after failure of treatment by gastroenteroscopy. Final pathological analysis revealed lymphangioma with thrombus and hemorrhage. After surgery, he no longer had decreased hemoglobin count, nor symptoms of anemia and melena. Also, at the last follow-up visit, the patient's hemoglobin count patient was normal and he returned to normal daily functions.

Keyword

Lymphangioma; Endoscopy; Surgery

MeSH Terms

Adult
Anemia
Endoscopy
Follow-Up Studies
Hemorrhage*
Humans
Ileum
Jejunum
Lymphangioma*
Lymphatic System
Melena
Thrombosis

Figure

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  Fig. 1 Video capsule endoscopy revealed mucosal erosion (A) with blood clot at jejunum (B) (at about 60 cm distal to the ligament of Treitz).

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  Fig. 2 Gastroendoscopy revealed mucosal erosions (A) on jejunum and performed bleeding control (C) by clipping due to chronic bleeding (B–D).

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  Fig. 3 Macroscopically, (A) the mucosal surface was showed multifocal erosion (A) and some bright yellow-white multiple submucosal lesions are observed in specimen (resected jejunum) (B).

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  Fig. 4 (A) Histologically, numerous dilated lymphatics are identified in submucosa in hematoxylin and eosin staining (×40). (B) The lymphatics are positive for D2-40 in immunohistochemical staining (×100). (C) Hematoxylin and eosin staining (×100).

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