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Session: ePoster: Benign Abdominal 1 (Sun8)

EP224 - Robotic Excision of a Rare Colonic Lymphovenous Malformation: A Case Report

Sunday, May 11, 2025
9:22 AM – 9:27 AM PT
Location: Monitor 2, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Kirbi Yelorda, MD

    Fellow
    Ichan School of Medicine at Mount Sinai
    New York, NY, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Heather Carmichael, MD

    Colorectal Surgery Fellow
    Icahn School of Medicine at Mount Sinai
    University of Colorado
    New York, NY, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • SK

    Sanghyun A. Kim, MD

    Associate Professor of Surgery
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • AB

    Alexander Bulanov, DO

    Assistant Professor of Surgery
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Kirbi Yelorda, MD: This individual has no financial relationships with ineligible companies.
Heather Carmichael, MD: This individual has no financial relationships with ineligible companies.
Alexander Bulanov, DO: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Lymphovenous malformations are developmental anomalies of the embryonic vascular system. While they have been documented in the extremities, mediastinum, retroperitoneal, and craniofacial regions, this is, to our knowledge, the first reported case of an intra-abdominal lymphovenous malformation

Methods/Interventions: A 26-year-old female with a history of right ovarian cyst presented to the emergency department with a three-day history of fever and right lower quadrant pain. A CT scan of the abdomen and pelvis revealed a 5.4 cm collection medial to the ascending colon, raising concerns for either an abscess or a mesenteric duplication cyst. An MRI performed on the same day confirmed similar findings. The patient was admitted for observation, and after her pain resolved, she was discharged on hospital day one, with plans for a follow-up colonoscopy. Six days later, a colonoscopy was performed and yielded normal results. Given the imaging findings and the potential for malignant transformation of a presumed mesenteric duplication cyst, a decision was made to proceed with a robotic right hemicolectomy. Intraoperatively, there were several feeding vessels which were cauterized and transected with a bipolar energy device. The cyst was then carefully peeled off the right colon. We reached a point in our dissection where the cyst was very firmly attached to an area of the right colon, rather than perform a formal bowel resection, we elected to wedge out this area of the colon using a Endo-GIA 60mm stapler. Using a 3-0 V lock suture the staple line was oversewn in a Lembert fashion. An omental pedicle flap was fashioned and sutured over the closure.

Results/Outcomes: Final pathology revealed fibroadipose tissue with lymphovascular spaces containing prominent clusters of histiocytes. Immunohistochemistry was positive for CD31 and D2-40, confirming the diagnosis of a lymphovenous malformation.

Conclusion/Discussion: Based on our experience, colonic venous lymphatic malformations can be safely excised using a wedge resection. If luminal narrowing is a concern, formal resection of the bowel segment containing the malformation is recommended. Although this is a rare condition, it is important for clinicians to consider it in the differential diagnosis when evaluating patients with cystic lesions in the lower gastrointestinal tract.