Intestinal lymphangiectasia is an obstruction of the lymphatic system. We report on a patient with mesenteric adenopathy and an elevated CA125 level, which were suspicious for peritoneal carcinoma. Further evaluation and bowel resection identified intestinal lymphangiectasia. This disease should be considered in patients with mesenteric adenopathy and a small bowel mass.
We present the case of a 46-year-old woman with abdominal pain after undergoing a liver biopsy for elevated liver function tests. Primary biliary cirrhosis was diagnosed on liver biopsy. In addition to a liver subcapsular hematoma, computed tomography (CT) identified mesenteric adenopathy that was thought to be consistent with carcinomatosis. Further assessment revealed a CA-125 level of 120 U/mL (range, 0–34 U/mL), a carcinoembryonic antigen level of 1.4 ng/mL (range, 0–5.4 ng/mL), a normal transvaginal ultrasound scan, and a right upper quadrant ultrasound scan that showed a fatty liver. Upper and lower gastrointestinal endoscopy demonstrated mild antral gastritis and sigmoid diverticulosis.
Case Report
Her medical history was significant for stage II primary biliary cirrhosis (newly diagnosed on liver biopsy), hypothyroidism, and chronic back pain. Surgical history was significant for back surgery and cervical fusion. She has no significant family medical history. She quit smoking approximately 1 year ago.
Abdominal CT scans reported multiple small mesenteric nodules and hypodense, lobulated, nonenhancing masses that abutted and encased the jejunum and ileum without intravenous contrast enhancement and multiple enlarged mesenteric lymph nodes ( Figure 1 ). These findings were suspicious for small-bowel lymphoma. However, these CT findings were unchanged in comparison to a scan that had been performed 9 months earlier. The uterus, fallopian tubes, and ovaries were normal.
The patient was taken to the operating room for a diagnostic laparoscopy and mesenteric lymph node biopsy. At the time of laparoscopy, there was significant mesenteric fullness and a nodular mass that involved a 10-cm segment of mid jejunum. No mesenteric adenopathy was identified, as noted on preoperative CT scan. Frozen sections of multiple mesenteric biopsy specimens were reported as fibroadipose tissue. A small-bowel resection was performed because of the concerns of impending obstruction and for definitive diagnosis.
Surgical pathologic findings showed yellow and focal white patches in the mesentery, with dilated semitranslucent cysts that ranged from 0.3–4.0 cm in size throughout the bowel wall and mesentery ( Figure 2 ). Milky-white fluid drained from these cysts on incision. Histologically, there are dilated lymphatic spaces throughout the full-thickness of the bowel wall ( Figure 3 ).
