Peripancreatic cystic lymphangioma with secondary hemorrhage: A rare case report

Lymphangiomas are thought to be true neoplasms, hamartomas or lymphangiectasias. Intra-abdominal lymphangiomas are rare and occur most frequently in children. This is a case report of a 27-year-old female with recurrent episodes of the left-sided upper abdominal pain of 2 years duration. She gives a history of intermittent nausea and vomiting. Liver function test and complete blood count with differential were normal. During the initial stages of illness, the serum lipase was elevated; the serum amylase level was normal all through the entire period. The upper gastrointestinal endoscopy suggested hiatal hernia and mild duodenitis. Two computed tomography scans done at 5 months interval showed a hypodense lesion in the distal tail of pancreas with irregular margins. The size of lesions had decreased from 15 mm × 14 mm to 13.5 mm × 10 mm during this period. Endoscopic ultrasound showed ill-defined area in the distal tail of pancreas and pseudocyst was suspected. Magnetic resonance cholangiopancreatography after 2 months showed a cystic lesion in the tail of pancreas of size 11 mm × 10 mm. Due to increasing severity of pain and fainting spells, the patient was taken up for a distal pancreatectomy. The histopathologic examination confirmed a diagnosis of peripancreatic cystic lymphangioma with secondary hemorrhage. During the postoperative period, the drain amylase was high suggestive of grade A pancreatic fistula. Gradually, the levels decreased, the patient became stable and discharged after pneumococcal vaccination.