Male Emergency Department, one month old, with no personal history of interest, who came for the third time to the last week with partially consolable crying.
She had been diagnosed with infantile colic and standard measures were recommended.
Take exclusive breastfeeding.
In the last 48 hours she takes the shots worse, the crying, which was initially evening, she stays all day and the mother can't calm him in her arms since yesterday.
The patient remains afflicted and has an excellent general condition. He presents adequate gain, currently enjoys a weight of 4 kg. The physical examination reveals an evident abdominal distension towards a flaccid mass at a perium level
Refuses breastfeeding in the emergency department frankly and presents vomiting food.
With suspected intestinal obstruction, an abdominal X-ray is performed in which there is a marked abdominal silence (absence of gas) in the right hemiabdomen and mass effect with displacement of the left intestinal loops towards the hemiabdomen.
Ultrasound shows an image of approximately 9 x 8.7 x 7.9 cm at the centroabdominal level, which behaves as a large focal lesion occupying a space of cystic characteristics without vascular flow at color Doppler and multiloculated and multita.
1.
It was decided to transfer to a reference center for pediatric surgery.
An abdominal magnetic resonance imaging (MRI) study was completed, in which an intra-abdominal cystic mass of about 90 x 60 x 65 mm appears, located mainly in the right flank and the centroabdominal region.
It extends from the lower hepatic border, in front of the right kidney displacing intestinal structures to the left.
It is a multilocular mass with well-defined borders and walls, with multiple cystic components of different sizes.
The first diagnostic suspicion in a cystic lymphangioma of the mesentery.
1.
The patient underwent a midline laparotomy and a multicystic mass with white fluid content depends on the mesentery of a loop in the middle ileum.
The loop was resected and end-to-end anastomosis was performed.
The postoperative period, the first 24 hours in the Pediatric Intensive Care Unit (PICU) and the rest in the ward, has evolved without incidents and in eight days is sent home with adequate enteral tolerance and without complications.
Histopathological examination confirmed the diagnosis of cystic lymphangioma when a multiseptated cystic mass of approximately 5 cm in diameter with a white mesenchymal wall of 0.1 cm was observed.
