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When Fever, Leukocytosis, and Right Lower Quadrant Pain Is Not Appendicitis

Kurbedin, Jeanette DO*; Haines, Lawrence MD, MPH, RDMS, FACEP; Levine, Marla C. MD; Dickman, Eitan MD, RDMS, FACEP

doi: 10.1097/PEC.0000000000001250
Illustrative Cases

Mesenteric cystic lymphangioma (MCL) is an uncommon, benign, slow-growing abdominal tumor that is derived from the lymphatic vessels (World J Gastroenterol. 2012;18:6328–6332, Radiographics. 1994;14:729–737). It is most often diagnosed in the head and neck of affected children. Rarely, a lymphangioma can develop within the small bowel (Pan Afr Med J. 2012;12:7). The clinical presentation of patients with an abdominal MCL can range from asymptomatic to acute abdominal pain (J Korean Surg Soc. 2012;83:102–106). We report a case of small bowel volvulus caused by an MCL in a 3-year-old child who presented to the pediatric emergency department with right lower quadrant pain. The child was thought to have a perforated appendicitis and was taken to the operating room where an MCL was identified and resected. This case illustrates the need to consider MCL when a patient presents to the emergency department with right lower quadrant pain.

From the *Emergency Medicine Attending, and †Division of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.

Disclosure: The authors declare no conflict of interest.

Reprints: Jeanette Kurbedin, DO, 164 Bank St, Manhattan, NY 10014 (e-mail:

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