Hemorrhagic ulcerative gastric lymphangioma in an infant: A case report

Introduction

Lymphangiomas are congenital malformations of the lymphatic system, mostly presenting in the head and neck during early childhood. Its occurrence in the stomach is exceedingly rare with no reported cases in infants to date. Due to its asymptomatic nature and the limitations of imaging studies in providing a definitive diagnosis, gastric lymphangioma poses diagnostic and therapeutic challenges in children.

Case presentation

A 6-month-old female was brought to the emergency department with a three-day history of poor sucking, fever and feeding intolerance. In addition, she had been suffering from frequent non-bilious vomiting and hematemesis for two months. On physical exam, she appeared pale and drowsy. Her abdomen was soft, though slightly distended in the upper region with a small palpable mass in the epigastric area. An upper GI study revealed a dilated stomach and duodenum suggesting a duodenal obstruction. The only abnormal laboratory study was a hemoglobin level of 6 mg/dl. Laparotomy revealed an obstructive band between the duodenum and jejunum causing mild stenosis, which was released. A mass was found within the stomach. Through a gastrotomy we identified a cystic mass involving the body of the stomach and two-thirds of the antrum, with ulceration of its surface. The mass was completely excised and sent for histopathological examination. The stomach was then closed along the greater curvature as in a sleeve-gastrectomy fashion. The pathology report was consistent with an ulcerated lymphangioma. At 18 months of follow up she remains asymptomatic and has appropriate weight gain.

Conclusion

Gastric lymphangioma poses both diagnostic and surgical challenges in infants. Although rare in this population, it should be considered in patients presenting frequent vomiting and hematemesis.