Mesenteric Lymphangioma Associated With 900-degree Small Bowel Volvulus Without Intestinal Necrosis: A Case Report

Abstract

A 4-year-old boy presented with a 5-day history of abdominal pain and vomiting. He had initially been treated for acute gastroenteritis at a previous hospital; however, the vomiting subsequently became bilious. Contrast-enhanced abdominal CT revealed intestinal volvulus associated with a cystic lesion, leading to his transfer to our hospital. During emergency surgery, an 18 × 13 cm cystic lesion in the small-bowel mesentery was identified, which had caused a 900-degree counterclockwise volvulus of the small intestine. After detorsion, the intestine was found to be viable without necrosis; the cyst was resected along with a 10 cm segment of the small intestine. Histopathological examination confirmed lymphangioma. This case represents a rare instance in which intestinal necrosis did not occur despite a 5-day clinical course and a severe 900-degree volvulus. One possible contributing factor was the subacute clinical course suggested by the chylous cyst contents. Additionally, the massive cyst within the confined abdominal space may have supported the torsion base from the caudal side. This mechanical support may have reduced stress on the mesentery, thereby preventing excessive stretching and compression of the mesenteric vessels.