Symptom Resolution and Volumetric Reduction of Abdominal Lymphatic Malformations With Sclerotherapy

• Published in: The Journal of surgical research 2019-01, Vol.233, p.256-261
• Main Authors: Madsen, Helen J., Annam, Aparna, Harned, Roger, Nakano, Taizo A., Larroque, Lauren O., Kulungowski, Ann M.
• Format: Article
• Language: English
• Subjects: Abdominal; Doxycycline; Lymphangioma; Lymphatic malformation; Pediatric; Sclerotherapy
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2018.07.031

Lymphatic malformations (LMs) are congenital and arise from errors in vascular embryogenesis. LMs are categorized by cyst size as microcystic, macrocystic, or combined. Abdominal LMs are rare. Surgical resection of abdominal LMs has been the mainstay of therapy, but recurrence and morbidity are high. We sought to determine the effectiveness of sclerotherapy treatment for abdominal LM. A single-center, retrospective review from 2014 to 2018 was conducted evaluating pediatric patients with abdominal LM. Ten patients were included, n = 9 had macrocystic LM and one patient had combined disease. The average age at first treatment was 6.8 y. The most common presenting symptoms were abdominal distention, pain, infection, and anemia. Preprocedural imaging was performed for all patients; median pretreatment volume was 1572.9 cm3 (range, 67.2-13,226.4). LMs were accessed using ultrasound guidance and injected with opacified doxycycline. Patients received a mean of 7.1 sclerotherapy injections. Complications included intraperitoneal doxycycline extravasation (n = 1), managed conservatively, and LM infection (n = 1), treated with intravenous antibiotics and drainage. One patient went on to surgical resection due to inability gain stable intracystic access; follow-up ultrasonography showed no recurrence. Postprocedural imaging was available in n = 8. Volume decreased by 96.7% after sclerotherapy. The median remaining volume was 0 cm3 (range, 0-599.7) (P = 0.016). Postsclerotherapy magnetic resonance imaging was obtained in n = 6, with complete resolution in 83.3%. All patients had resolution of presenting symptoms. Follow-up duration was 12.3 mo. Initial results demonstrate that sclerotherapy is an effective and durable treatment for symptom resolution and volume reduction of abdominal LM.