H. J. Madsen1,2,5, A. Annam2,3,5, R. Harned2,3,5, T. A. Nakano2,4,5, L. O. Larroque1,2, A. M. Kulungowski1,2,5 1Children’s Hospital Colorado,Divsion Of Pediatric Surgery,Aurora, CO, USA 2Children’s Hospital Colorado,Vascular Anomalies Center,Aurora, CO, USA 3Children’s Hospital Colorado,Interventional Radiology,Aurora, CO, USA 4Children’s Hospital Colorado,Center For Cancer And Blood Disorders,Aurora, CO, USA 5University Of Colorado,School Of Medicine,Aurao, CO, USA
Introduction: Lymphatic malformations are congenital lesions that arise from errors in vascular embryogenesis. Cystic lymphatic malformations are categorized based on the size of the lymphatic channels as microcystic, macrocystic, or combined. Abdominal lymphatic malformations are rare. Surgical resection of abdominal lymphatic malformations has been the mainstay of therapy but recurrence is high. We sought to determine the effectiveness of sclerotherapy for the treatment of abdominal lymphatic malformation with regards to symptom resolution and volume reduction.
Methods: A single-center, retrospective review from 2014-2017 was conducted evaluating patients with abdominal lymphatic malformations.
Results: Eight patients were included; 7 patients were male. Macrocystic lymphatic malformation was the predominant type (n=7); one patient had microcystic disease. The average age at time of first treatment was 6.8 years (range, 0-17 years). The most common presenting symptoms were distention (n = 7), abdominal pain (n = 6), infection (n = 2) and anemia (n = 1). Preprocedural cross-sectional imaging was performed for all patients with an average pretreatment volume of 2983.7cm3 (± 4228.6 cm3). Lymphatic malformations were accessed using ultrasonographic guidance followed by injection of opacified doxycycline. Patients were treated with a mean of 7.75 cycles (range, 2-16 cycles) of doxycycline sclerotherapy. Catheters were left in place for a median of 3 treatments (range, 1-7 treatments). Complications included: intraperitoneal extravasation of doxycycline (n = 1) and infection of the abdominal lymphatic malformation (n=1). The extravasation was managed conservatively and remained asymptomatic. The infection was treated successfully with intravenous antibiotics and drainage. One patient went on to surgical resection of the lymphatic malformation due to inability gain access to the lymphatic malformation. Postprocedural imaging was available for 87.5% (7/8) patients; one patient is awaiting posttreatment imaging. Magnetic resonance imaging was obtained after sclerotherapy for 6 patients with 83.3% (n = 5) showing resolution of the lymphatic malformation. Lymphatic malformations’ volumes decreased by 97.1% after sclerotherapy. The average remaining volume was 85.7 ± 226.7 cm3 (p = 0.07). The patient undergoing surgical resection had follow-up abdominal ultrasonography that showed no recurrence. All patients had resolution of presenting symptoms. Follow-up duration was 11.8 months (range, 6-24 months).
Conclusion: Initial results demonstrate that sclerotherapy is a safe and effective treatment for abdominal lymphatic malformations providing symptom resolution and volumetric reduction.
