A retrospective study about lymphangioma of the mesentery: An unusual cause of bowel volvulus

Mesenteric lymphangioma is a rare benign lesion, and volvulus secondary to mesenteric lymphangioma is even less common, yet it can lead to severe complications. We retrospectively analyzed the clinical characteristics of pediatric patients with volvulus caused by mesenteric lymphangioma. Between January 1994 to August 2024, 28 pediatric patients were diagnosed with bowel volvulus attributable to mesenteric lymphangioma. Age, sex, clinical manifestations, ultrasound and computed tomography (CT) findings, operative findings, treatment, complications, and follow-up outcomes were reviewed retrospectively. The cohort comprised 13 boys and 15 girls, with 71.4% being preschool-aged. Most patients (21/28, 75%) sought medical attention within 24 hours of symptom onset. Clinical signs and symptoms were nonspecific and resembled those of intestinal obstruction. Ultrasound detected mesenteric lymphangioma in 26 patients, and CT identified it in all 28 patients; the "whirlpool sign" was observed in 24 and 27 patients, respectively. All patients underwent emergency laparotomy. Intestinal necrosis occurred in 5 cases and was associated with longer consultation delays (P = .008) and higher degrees of rotation (P = .008). Surgical procedures included resection of the affected intestinal segment with end-to-end anastomosis (20 patients), tumor enucleation (6 patients), and marsupialization with endometrial cauterization 2 patients. Postoperative complications consisted of bowel obstruction and incision infection in 2 patients. No recurrences were noted during follow-up. Volvulus secondary to mesenteric lymphangioma is a rare condition that presents with nonspecific clinical features. It should be considered in the differential diagnosis of acute abdominal pain in children.