Laparoscopic Excision of an Abdominal Lymphatic Malformation

Abdominal lymphatic malformations can be discovered incidentally or become acutely symptomatic due to torsion, hemorrhage, rupture, or sudden enlargement.

A 15-year-old girl presented with several days of non-localizing abdominal pain.

Ultrasound followed by CT scan demonstrated a large cystic mass thought to be of adnexal origin extending into the upper abdomen.

Initial laparoscopic exploration supported the presumptive diagnosis of a cystic mass arising from the pelvis.

Further manipulation demonstrated non-pelvic origin with normal adnexa.

The mass was connected by a torsed pedicle traveling over the transverse colon through the greater omentum.

Further dissection demonstrated the omentum to be simply adherent to the torsed pedicle and not the source of it.

The mass was attached to the gastric wall and extended posterior to the stomach into the lesser sac.

A ligature device was used to separate the mass from the gastric wall at the junction.

The greater curvature was completely intact and uninvolved following excision.

The mass arose from the lesser curvature mesentery and occupied the lesser sac.

The stomach was tested for leak after installation of dilute methylene blue through the nasogastric tube; none was identified.

The mass was removed through the 10 millimeter umbilical port.

The patient was started on oral intake a few hours after the operation and discharged the following day.

All symptoms resolved postoperatively.

A screening ultrasound one year after excision showed no recurrence.

Lymphatic malformation was diagnosed grossly and histologically.

Had this lesion been approached by a Pfannenstiel incision, a correct diagnosis and excision would not have been possible without a second laparotomy incision.