Journal of Postgraduate Medicine
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CASE REPORTS
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Year : 1992  |  Volume : 38  |  Issue : 4  |  Page : 206-7  

Multiple chylous cysts of abdomen causing intestinal obstruction.

MM Kamat, NK Bahal, SR Prabhu, MV Pai 
 Dept of Surgery, Topiwala National Medical College, Bombay, Maharashtra.

Correspondence Address:
M M Kamat
Dept of Surgery, Topiwala National Medical College, Bombay, Maharashtra.

Abstract

A case of multiple chylous cysts of the abdomen in a 35 years old female is presented here. The patient presented with signs and symptoms of acute intestinal obstruction. Exploratory laparotomy revealed few intestinal adhesions along with multiple small cysts containing blood stained gelatinous material in the abdominal cavity, some of which were excised alongwith lymph nodes. The abdomen was closed after a saline peritoneal lavage. Chylous nature of the cysts was confirmed on histopathology. The post-operative course was asymptomatic.



How to cite this article:
Kamat M M, Bahal N K, Prabhu S R, Pai M V. Multiple chylous cysts of abdomen causing intestinal obstruction. J Postgrad Med 1992;38:206-7


How to cite this URL:
Kamat M M, Bahal N K, Prabhu S R, Pai M V. Multiple chylous cysts of abdomen causing intestinal obstruction. J Postgrad Med [serial online] 1992 [cited 2019 Dec 7 ];38:206-7
Available from: http://www.jpgmonline.com/text.asp?1992/38/4/206/666


Full Text




  ::   IntroductionTop


Chylous cyst, a rare abdominal mesenteric cyst, is difficult to clinically differentiate from enteric and dermoid mesenteric cysts[1]. A single chylous cyst is not uncommon but presence of multiple cysts is an unusual occurrence[2]. We report one such case here.


  ::   Case reportTop


A 35-year-old female presented with coiicky abdominal pain, vomiting, mild abdominal distension and constipation for 2 days. She had a similar attack a few months ago, which was treated conservatively. The pain was intermittent and located near the umbilicus. Vomiting was bilious in nature. Physical examination revealed a soft distended abdomen with diffuse tenderness but no rebound tenderness. No lump was palpable. Bowel sounds were markedly increased. A skiagram showed multiple fluid levels. A clinical diagnosis of acute intestinal obstruction was made. Laboratory investigations were within normal limits.

The patient was managed conservatively for 24 hrs. The increasing tachycardia and abdominal tenderness warranted an emergency exploration.

The entire peritoneal surface was studded with multiple, small, thin walled cysts, which contained blood stained gelatinous material. No definite pathology was found in the small or large bowel. Mesenteric lymph nodes were enlarged. A few adhesions, which were present in the small bowel, were separated. Some cysts and lymph nodes were excised and biopsied. The abdomen was closed after a saline peritoneal lavage.

A histopathological examination revealed features of chylous cysts. The section showed a cyst wall lined by flat to low cuboidal enclothelial cells. Lymph nodes showed a reactive hyperplasia (See [Figure:1]). The post-operative recovery was uneventful. The patient has remained asymptomatic, over the 9 month follow-up.


  ::   DiscussionTop


Multiple chylous cysts of mesentery giving 3 rise to intestinal obstruction is a rare entity. The etiopathogenesis of the obstruction seen in our case is not clear but it could be due to rupture of few cysts. The contents of this cyst might have given rise to adhesions between intestinal loops.

True chylous cysts take two forms: the chylangioma and the chyle- filled lymphatic cysts, which result from obstruction. According to Ewing[4], the chylangioma is a lymphangioma-a benign tumour of embryonic originoccurring like most lymphangiomas in embryonic lymphoid centres.

The tumours may be single and multi-locular, or multiple and small[2]. Ewing[4] describes them, like lymphangiomata elsewhere, as consisting of enclothelial and connective tissue elements. Chyle, fibrin, inspissated fat and blood may be found in the cyst? The endothelium may be smooth, or proliferating and irregular or patchy.


  ::   AcknowledgmentTop


We are grateful to Dr (Mrs) KD Nihalani, Dean, Topiwala National Medical College and BYL Nair Charitable Hospital, for permitting us to publish this case report.

References

1 Steinrich OS. Diagnosis of mesenteric cyst. Ann Surg 1955; 142:889-890.
2Ford JR. Mesenteric cyst. Am J Surg 1960; 99:878-886.
3Handelsman JC, Ravitch MM. Chylous cyst of mesentery in children. Ann Surg 1954; 140:185-193.
4Ewing J. Neoplastic Diseases. 4th ed. Philadelphia: WB Saunders; 1940.

 
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