[Idiopathic intestinal lymphangiectasis with enteral albumin loss syndrome].
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Although rarely, several conditions may cause malabsorption through lymphatic obstruction. Primary lymphangiectasia, a genetically determined disease characterized by diarrhoea, steatorrhoea and protein-losing enteropathy, is one of these conditions. The Authors report their experience in three cases of small bowel lymphangiectasia occurring in adults and discuss diagnostic and therapeutic problems of the disease.
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The authors describe a rare case of primary intestinal lymphangiectasis resolved with surgical treatment. Usually the natural course of the disease is relatively mild and medical nutritional treatment can be sufficient. In this case the lymphatic intestinal anomaly was generalized to the entire small intestine but a distal ileal segment was particularly involved. The surgical resection of this intestinal tract resolved the symptomatology.
A case of idiopathic intestinal lymphangiectasis is reported in a three month old child. Clinical course and laboratory findings are given in relation to administration of three diets containing different concentrations and types of fat. Short term improvement was only noticed with diets containing low concentrations of long chain triglycerides supplement with medium chain triglycerides. Clinical manifestations related to fat malabsortion improved greatly but there was no relationship with serum protein level. No effect on low level of gamma-globulins and lymphatic displasia was found as sawn in an intestinal biopsy performed after three months of treatment. Nevertheless, long-term results were poor and only were evident in a diminution of steatorrhea and normalization of stools.
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We discuss a newborn with congenital intestinal lymphangiectasia. Primary intestinal lymphangiectasia is a rare disease which represents a congenital disorder of mesenteric lymphatics and is associated with typical clinical signs. The diagnosis can be made on the basis of the typical histological findings in the endoscopic biopsies, the laboratory findings and the radiographic findings. Treatment is palliative by introduction of medium chain triglycerides and by restricting the dietary fat intake. Substitution therapy may be necessary. The longer-term prognosis appears to be good.
This article describes two new cases of primary intestinal lymphangiectasia: the first one refers to a 10-years-old girl, who failed to thrive, while the second one was discovered in a 19-months-old female infant, who presented with anasarca. In both cases gastroduodenal endoscopy allow us to put the diagnosis, revealing the presence of the typical duodenal lesions, due to dilatation of the lymphatic vessels and loss of the lymph. The typical endoscopic features found in both cases are here described; at the same time, the major role of the intestinal biopsy via endoscopic route is outlined, since this is the only method which allow to perform targeted biopsies.
A 32-year-old woman with congenital intestinal lymphangiectasia (CIL) and warts (condylomata acuminata) was found to have bowenoid papulosis, Bowen's disease and squamous-cell carcinoma, at first in the anus, later also in the vulva. Limited surgical measures and laser vaporization with systemic and topical administration of interferon controlled the tumour development for some time. But after 7 years the squamous-cell carcinoma recurred with infiltration of the outer anogenital region. The patient then had an episode of thrombotic cerebral ischemia, which prevented a planned abdominoperineal resection with radical vulvectomy. Instead she received chemotherapy with bleomycin, mitomycin and cisplatin. But she died 8 weeks later, from tumour cachexia. Occurrence of a squamous-cell carcinoma of the anus and vulva in this young patient suggests a high oncogenic potential of the papilloma virus (HPV) infection. The latent period was probably shortened by a cellular immune deficiency as part of CIL. Treatment of the various carcinomatous manifestations should as long as possible be by local measures and interferon administration.
A case of primary intestinal lymphangiectasia in a 40-year old patient is described. The diagnosis was rendered more difficult by the association of this disease, breast cancer and the mistaken diagnosis of neoplastic cells in the pleural fluid. The clinical situation, laboratory and radiological findings, and biopsy results are compared with findings reported in the literature. A rapid, long-term improvement was obtained by the administration of a hypolipidic diet containing medium chain length fats.
A literature review of intestinal lymphangiectasia in the dog is presented. A Yorkshire terrier with acquired lymphangiectasia as the result of enteritis is described. The single clinical symptom was marked ascites. Diagnosis was confirmed by histology, demonstrating dilated lymph vessels in the intestinal villi of the duodenum.
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A child is described with a portal cavernoma and marked growth retardation who was found to have intestinal lymphangiectasia. It is proposed that the lymphangiectasia may be secondary to portal hypertension. This suggestion is supported by the improvement in lymphopenia after a splenorenal shunt cavernome.