Small bowel lymphatic malformation: Clinical presentation and a comprehensive literature review

Table 2 Management, histopathology, and outcomes

Ref.	Management (surgery/endoscopy)	Histopathology findings	Type	Complications (post-operative)	Follow-up duration	Recurrence
Akwei et al[46]	Surgical resection (incomplete)	Complex multiloculated lesion; flattened cells, vascular channels, lymphoid aggregates	Cystic	Infection, pelvic collection (E. coli), required CT-guided drain	1 year	Intra-abdominal collection (1 month); no cyst recurrence
Al-Obeed and Abdulla[45]	Laparoscopic right hemicolectomy	Dilated lymphatic vessels	Cystic	None	Not addressed	Not addressed
Barghash et al[44]	Segmental bowel resection	Dilated thin-walled channels/cystic spaces; flat endothelial cells, lymphocytes, RBCs	Cystic	None	8 weeks	Not specified (risk noted)
Bucciero et al[43]	Surgical resection (duodenum/jejunum)	Dilated lymphatic vessels; histiocytes, lymphangiectasia	Lymphatic malformation	Not addressed	Not addressed	Not addressed
Cai et al[42]	Surgical resection	Dilated lymphatic channels (mucosa/submucosa); simple lymphatic malformation with bleeding	Simple	None	Not specified	No melena recurrence
Chae et al[40]	Surgical resection	Multi-septate cystic masses; flat lymphatic endothelial cells	Cystic (macrocystic)	None	3 months	None
Chen et al[41]	Laparotomy	Dilated lymphatic channels; factor VIII+, actin+, cytokeratin-	Cystic	None	18 months	None
Chung et al[7]	Surgical excision	Dilated lymphatic spaces; collagenous stroma, flattened endothelial cells	Cystic	None	9 months	None
Creger et al[39]	Laparoscopy to open small bowel resection	Lymphatic malformation; no malignancy	Cystic	None	2 weeks	Not addressed
Cupido and Low[5]	Conservative (follow-up); surgery if symptomatic	Not specified (cystic lymphatic malformation)	Cystic	Not addressed	13 months	Not addressed
Du et al[38]	Not specified	Haemolymphangioma (CD34+, D2-40+)	Cystic	None	4 months	None
Hwang et al[37]	Laparoscopic resection	Haemolymphangioma (CD34+, D2-40+)	Cystic	None	4 months	None
Ignjatovic et al[13]	Laparoscopic abdominal transanal resection + ileostomy	Dark red multiloculated cystic lesion; CD34+ endothelial cells	Cavernous	Not addressed	Not addressed	Not addressed
Honda et al[14]	Surgical resection	Cystic lymphatic malformation	Cystic	None	1 year	None
Iwaya et al[36]	Surgical resection	Dilated lymphatic vessels; eosinophilic fluid/RBCs	Lymphatic malformation	Not addressed	Not addressed	Not addressed
Jang et al[35]	Laparoscopic small bowel resection	Dilated vascular channels; D2-40+ (lymphatic), CD31+ (blood)	Hemangiolymphangioma	Not addressed	Not addressed	Not addressed
Jayasundara et al[34]	Segmental resection + anastomosis	Lymphatic malformation	Cystic	Ischemic stricture	20 days	Complete small bowel volvulus
João et al[33]	Surgical excision	Thin-walled lymphatic spaces; eosinophilic material, neutrophils, lymphocytes	Cystic	None	6 months	Not addressed
Khan et al[52]	Endoscopic mucosal resection	Large dilated lymphatic channels	Cavernous	None	2 months	None
Konstantinidis et al[32]	Diagnostic laparoscopy to laparotomy (intussusception)	Cystic lymphatic malformation (irregular cysts)	Cystic	None	2 weeks	Not addressed
Kopáčová et al[51]	Laparoscopic resection	Multicyclic lymphatic malformation; markedly dilated channels	Cystic	None	Not addressed	Not addressed
Li et al[31]	Endoscopic resection (DBE)	Small-bowel lymphatic malformation	Cystic	None	4 months	Not addressed
Lim et al[50]	Surgical resection	Dilated lymphatics; thrombus/hemorrhage	Lymphatic malformation	Chronic anemia/melena (pre-operative); resolved post-op	3 months	None
Losanoff et al[29]	Exploratory laparotomy	Cystic mass; attenuated endothelium, smooth muscle, lymphocytes	Cystic	Hemorrhage, infection, lymphatic fistula (risk)	Not addressed	0%-100% (risk)
Mavrogenis et al[30]	Single-port laparoscopy	Mixed cavernous hemangioma-lymphatic malformation	Mixed	Not addressed	Not addressed	Not addressed
Botey et al[49]	Emergency laparotomy to bowel resection	Mesenteric lymphatic malformation; D2-40+	Cystic	Not addressed	Not addressed	Not addressed
Nakamura et al[28]	Endoscopic mucosal resection	Lymphatic malformation	None	Not addressed	Not addressed
Stein et al[15]	Open biopsy to alcohol ablation	Microcystic lymphatic malformation (small lymphatic channels)	Microcystic	Mild pain/fever (alcohol ablation)	18 months	None (no bleeding recurrence)
Ong et al[27]	Not addressed	Not addressed	Not addressed	Not addressed	Not addressed	Not addressed
Rieker et al[4]	Complete excision	Dilated lymphatic channels; factor VIII+, Ulex europaeus+	Cystic	None (initial); readmitted at 6 months	6 months (readmission)	Possible (incomplete removal risk)
Rathod et al[26]	Surgical excision	Smooth capsulated cysts; chalky white fluid	Cystic	None	Not addressed	Not addressed
Rojas and Molina[25]	Laparotomy	Encapsulated fat; dilated lymph vessels	Cavernous	None	Not specified	None (incomplete resection risk)
Lin et al[24]	Exploratory laparotomy	Dilated lymphatic channels; D2-40+	Cystic	Not addressed	Not addressed	Not addressed
Safatle-Ribeiro et al[23]	Surgical resection	Diffuse dilated lymphatic vessels	Cystic	Bleeding/wall thickness	42 months	None
Samuelson et al[22]	Not addressed	Not addressed	Not addressed	Cachexia, multiple cancers	Not addressed	Not addressed
Tang et al[47]	Laparoscopic segmental resection	Cavernous lymphatic malformation	Cavernous	Not addressed	Not specified (bleeding/anemia resolved)	Not addressed
Teng et al[21]	Excisional surgery	Chronic inflammation; low-grade neoplasia	Hemolymphangioma	None	6 months	None
Tomizawa et al[20]	Exploratory laparotomy	Cystic spaces with hemorrhage; D2-40+	Lymphatic malformation	Not addressed	Not specified	Not addressed
Torashima et al[19]	Laparotomy to bowel resection	Multicyclic spaces; attenuated endothelium, proteinaceous fluid	Cystic	None	18 months	None
Wei et al[48]	Emergency laparotomy to bowel resection	Dilated thin-walled channels; full-thickness bowel involvement	Lymphatic malformation	None	3 months	None
Yang et al[18]	Laparoscopic-assisted resection	Diffuse proliferative blood/Lymphatic vessels	Hemolymphangioma	Not addressed	1 year	Not addressed
Yavuz et al[17]	Enucleation (10), bowel resection (4), laparoscopic excision (4), hemicolectomy (3)	Simple cyst (17), lymphatic malformation (4), adenocarcinoma (1)	Cystic (simple/Lymphangioma)	SSI (3), anastomosis leak (1)	Not addressed	Not addressed
Yeh et al[16]	LABS (27), converted laparotomy (6)	Lymphatic malformation (1 case)	Lymphatic malformation	Transient fever/abdominal pain (tattoo leak)	14 ± 3 months	Symptomatic recurrence (2)

DBE: Double-balloon enteroscopy; LABS: Laparoscopy; RBC: Red blood cell; E. coli: Escherichia coli; SSI: Surgical site infection.