Case ReportColonic mesenteric lymphatic malformation presenting as an intraabdominal abscess in an infant: A case report

- Intraabdominal lymphatic malformations present most commonly in the small bowel mesentery (60%), mesocolon (24%), and retroperitoneum (14.5%).
- Cystic lymphatic malformations are classified as macrocystic, microcystic, or mixed cystic.
- Complications can include abscess, intestinal obstruction, volvulus, bleeding, and/or rupture.
- Secondary abscess formation may result in incomplete characterization of the pathologic process at the time of frozen section interpretation.
- Resection of bowel may be necessary in cases where the mesentery is involved.

IntroductionLymphatic malformations are low-flow vascular malformations most commonly located in the head and neck; isolated intraabdominal involvement is rare.Presentation of caseAn 8-month-old previously healthy male presented with a 9-day history of fevers. On examination, right-sided abdominal tenderness was noted. Ultrasound revealed a large heterogeneous mass, and CT scan revealed a rim-enhancing cystic mass adjacent to the right colon. Laboratory investigation including blood cultures was normal. His fever resolved with broad-spectrum antibiotics. Diagnostic laparoscopy revealed a large, firm mass arising from the mesentery of the right colon. An open right hemicolectomy with ileocolonic anastomosis was performed. The infant tolerated the procedure well, and he was discharged home on postoperative day four, pathologic examination identified a mesenteric lymphatic malformation with secondary abscess formation.ConclusionThis atypical presentation of an uncommon entity was instructive in several ways, particularly illustrating the diagnostic pitfalls that can be introduced by superinfection.