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Special Feature
July 1, 2005

Image of the Month—Diagnosis

Arch Surg. 2005;140(7):706. doi:10.1001/archsurg.140.7.706

Intra-abdominal cystic lymphangiomas are extremely rare entities whose origins are related to congenital defects of the lymphatics. Lymphangiomas generally occur in children, who remain asymptomatic until early adulthood. Lesions may be discovered incidentally or progress to produce vague and chronic abdominal symptoms, possibly secondary to a mass effect.1 Lymphangiomas do not generally regress. As such, surgical intervention is preferred and, with complete resection, offers an excellent prognosis. Two independent studies reported recurrences in 10% of patients in whom primary resection was incomplete.1,2 Chylous ascites may occur if the stem of the cyst and feeding lymphatics are unsuccessfully ligated.3 Management of this condition may include the placement of drains as they facilitate the injection of fibrinogen and thrombin, especially when drainage is persistent.4