Mesenteric Cystic Lymphangioma of the Proximal Jejunal Mesentery in a 72-Year-Old Man: A Rare Case Report and Literature Review

Abstract

Background: Mesenteric cystic lymphangioma (MCL) is a rare benign lymphatic malformation that is usually identified in childhood and is exceptional in adults. Its nonspecific presentation and overlapping imaging features can make preoperative diagnosis difficult. Case Presentation: A 72-year-old man with no significant medical history presented with intermittent epigastric pain and abdominal heaviness of one year's duration. Abdominal examination and biological assessment were unremarkable. Contrast-enhanced computed tomography demonstrated a well-defined intraperitoneal cystic lesion measuring 75 × 53 × 67 mm, without mural nodules or solid components, and mesenteric cystic lymphangioma was suspected. Exploratory laparotomy identified a multiloculated cyst arising from the mesentery of the first jejunal loop, approximately 10 cm distal to the duodenojejunal junction. Careful dissection preserved the jejunal mesenteric vascular arcades, allowing complete en bloc excision without cyst rupture or bowel resection. Histopathological examination showed variably sized cystic spaces lined by flattened endothelial cells without cytological atypia, confirming benign mesenteric cystic lymphangioma. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. Conclusion: Mesenteric cystic lymphangioma should be considered in the differential diagnosis of intra-abdominal cystic lesions in adults, including elderly patients. Complete surgical excision can provide definitive diagnosis and treatment, and bowel preservation may be feasible when the lesion can be separated safely from the mesenteric vascular supply.