1. Operative Management of Intra-abdominal Lymphatic Malformations in Children: A Single Tertiary Center Experience.
- Author
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Hyvönen, Hanna, Aronniemi, Johanna, Salminen, Päivi, and Kyrklund, Kristiina
- Abstract
Intra-abdominal lymphatic malformations (LMs) are relatively rare congenital anomalies and can be divided into intra- and retroperitoneal subgroups. This study aims to evaluate the outcomes after surgical resection of intraperitoneal LMs in children. The records of all patients ≤16 years of age with intraperitoneal LMs managed at our tertiary center between 2007–2022 were reviewed. Patients with retroperitoneal LMs were excluded. Our preferred approach is surgical exploration for large (>5 cm), symptomatic lesions if they are potentially resectable on imaging. A total of 12 patients (10 males) were diagnosed with intraperitoneal LMs located in the small bowel mesentery or omentum at a median age of 6.6 (range, 0.6−14.4) years. Ten (83%) patients presented with acute symptoms, including abdominal pain (n = 8; 67%) and vomiting (n = 3; 25%). Two (17%) intraperitoneal LMs were found on imaging performed for other reasons. Surgical exploration was performed in 11/12 (92%) cases. Intestinal volvulus around a mesenteric macrocyst had occurred in 4 (36%) patients. Complete macroscopic resection was achieved in 10/11 (91%) patients. Most lesions were localized to a short intestinal segment. One mixed type LM with an extensive mesenteric involvement was biopsied as the lesion was deemed to be unresectable in preoperative imaging and the diagnosis was initially unclear. There was one recurrence (8%) during postoperative follow-up on imaging (median 3.6 (range, 1.5−6.9) years) but the patient has remained asymptomatic and not undergone interventions. 6/8 (75%) of screened intraperitoneal LMs were positive for a somatic PIK3CA mutation. Most large, pedunculated macrocystic LMs in the small bowel mesentery or omental location were amenable to macroscopic resection. Intraperitoneal LMs tend to present with acute symptoms including a risk for intestinal volvulus based on anatomical location. Our results suggest low recurrence rates or need for further interventions over follow-up. III. • What is currently known about this topic? Both surgery and sclerotherapy have been described as treatment options for symptomatic intra-abdominal lymphatic malformations (LMs). Optimal therapeutic approach to intra-abdominal LMs has not been determined yet. • What new information is contained in this article? Description of outcomes after surgical treatment of intraperitoneal LMs. Comparison of outcomes to available literature is essential for developing therapeutic approaches for intra-abdominal LMs which tend to present acutely. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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