Partial resection of a giant intra-abdominal cystic lymphangioma with no recurrence for 10 years: a case report

Introduction: Cystic lymphangioma is a rare benign malformation of the lymphatic system, predominantly observed in pediatric populations. Its occurrence in adults is uncommon. Among the various forms, mesenteric and retroperitoneal cystic lymphangiomas are the most frequently encountered in the abdominal region. Case presentation: A 19-year-old male presented to the emergency department with acute abdominal pain. Abdominal computed tomography (CT) revealed a large cystic mass in the left abdominal quadrant, raising suspicion for a cystic lymphangioma. Intraoperative exploration revealed a giant cystic lesion firmly adherent to the mesenteric root and rectum. Complete excision was considered too risky due to the potential for fatal hemorrhage and injury to adjacent vital structures. As a result, the cyst was decompressed through aspiration, followed by partial resection of the cyst wall. The postoperative course was uneventful, and no recurrence was noted during a 10-year follow-up period. Clinical discussion: Cystic lymphangiomas are benign vascular malformations resulting from developmental anomalies of the lymphatic system. While often asymptomatic, abdominal lymphangiomas can present with symptoms when they enlarge, including acute abdominal pain, nausea, vomiting, weight loss, abdominal distension, and fever, particularly in cases of infection. Imaging modalities such as ultrasonography and CT scans are instrumental in lesion identification and characterization; however, definitive diagnosis relies on histopathological confirmation. Surgical resection remains the mainstay of treatment. Conclusion: Cystic lymphangioma is a rare benign tumor, and its clinical presentation in adults remains poorly characterized. Surgical management is the cornerstone of therapy. When feasible, total excision is the preferred approach; however, partial resection may represent a valid alternative in select cases, offering favorable outcomes with minimal morbidity and a low recurrence rate.