This is a 15-year-old patient with no remarkable pathological history.
He had abdominal pain of 4 years of evolution of colic type, of variable duration and postprandial predominance, located in hypogastrium and mesogastrium with loss of 5 kg of weight due to the voluntary decrease of intake by pain.
She reported occasional vomiting and constipation.
She remained afflicted at all times.
Assessed by his family doctor and a specialist in Gastroenterology, blood tests were performed which were normal, fibrogastroscopy and erradication treatment for H. pylori positive symptoms, which improved the urease test.
She was referred to Psychiatry to rule out an eating behavior disorder.
Physical examination revealed thinness (BMI 18) and tenderness in the hypogastrium with a soft mass sensation in the infraumbilical area.
All blood tests performed, including tumor markers, were normal.
Abdominal ultrasound showed a polylobulated hypogastric mass of at least 10 cm in diameter with dense liquid content in areas of larger size.
After gynecological examination, the mass was ruled out to depend on the genital tract.
An abdominal CT scan showed a malformation of the proximal loops of the small intestine and, at the pelvic level, a horizontal image in a "arena clock" of homogeneous cystic content, without a defined wall, which was not real.
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The radiological diagnosis was a probable mesenteric cyst with intestinal loop malposition.
The intestinal transit showed incomplete volvulus in the first jejunal volvulus with malposition and displacement of the jejunal and ileoileum towards the right vacuum.
That same day the patient presented intense abdominal pain with nausea and vomiting, absence of emission of feces and gases and abdominal distension, which improved with absolute diet, rehydration and potent analgesia.
The patient underwent surgery and a supra and infraumbilical midline laparotomy was performed, revealing a large mass about 20 cm in diameter, of liquid content, which was born from the intestinal mesocolon.
Cystectomy and resection of the encompassed jejunal loop were performed.
The pathology report was a cystic mass adhered to the serosa of the intestinal loop, composed of numerous cystic spaces, some multiloculated, containing an acellular serous substance, lined by endothelium.
The diagnosis was mesenteric cystic lymphangioma.
The jejunal loop showed no alterations.
The postoperative period was normal and the patient is asymptomatic without tumor recurrence in the ultrasounds performed after more than 3 years of follow-up.
