A Case of Small Intestinal Lymphatic Malformation with Intestinal Volvulus

Abstract

A 37-year-old man presented with abdominal pain, distension, and vomiting. He was referred to our hospital with suspected intestinal obstruction. Abdominal computed tomography (CT) showed extensive small bowel dilation and a whirl sign in the pelvic cavity, along with a cystic mass on the pelvic floor, which was difficult to differentiate from ascites. Emergency surgery was performed for a diagnosis of strangulated intestinal obstruction due to small intestinal volvulus. Intraoperatively, a 12-cm, yellow, cystic mass was found extruding from the ileum, 90 cm proximal to the terminal ileum, with a similar 5-cm mass in the adjacent mesentery. The small intestine had twisted 540° counterclockwise around this region. No ischemic changes were noted, and detorsion with partial small bowel resection, including the mass, was performed. Histopathological examination confirmed lymphatic malformation of the small intestine and mesentery. Including this case, 23 cases of small intestinal volvulus associated with lymphatic malformations have been reported in Japan, but this is the only case in which the primary lesion was a cystic mass in the bowel wall rather than the mesentery.