How to treat an extensive form of primary intestinal lymphangiectasia?

World J Gastroenterol. 2015 Jun 21;21(23):7320-5. doi: 10.3748/wjg.v21.i23.7320.

Abstract

We report a case of a 42-year-old man with a rare disorder known as primary intestinal lymphangiectasia, which is characterized by dilated intestinal lymphatics that lead to the development of protein-losing enteropathy. The patient presented with a grand mal seizure caused by malabsorption-derived electrolytes and a protein disorder. Signs of the disease, including chronic diarrhea and peripheral edema, manifested 10 years ago, but a diagnosis was never made. The diagnosis was suspected because of the clinical manifestations, laboratory tests, imaging and endoscopic findings. Hyperemic and edematous mucosa of the small intestine corresponded to scattered white spots with dilated intestinal lymphatics and whitish villi in the histological specimen of the biopsied jejunal mucosa. Although numerous therapeutic strategies are available, only octreotide therapy proved to be an effective means of therapeutic resolution in this patient. Although the patient had a partial remission following the use of a slow release formula of octreotide, his prognosis, clinical course, and future treatment challenges are yet to be determined.

Keywords: Diet; Malabsorption; Octreotide; Primary intestinal lymphangiectasia; Seizure; Treatment.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Biopsy
  • Double-Balloon Enteroscopy
  • Epilepsy, Tonic-Clonic / etiology
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Intestines / diagnostic imaging
  • Intestines / drug effects*
  • Intestines / pathology
  • Lymphangiectasis, Intestinal / complications
  • Lymphangiectasis, Intestinal / diagnosis
  • Lymphangiectasis, Intestinal / drug therapy*
  • Lymphedema / complications
  • Lymphedema / diagnosis
  • Lymphedema / drug therapy*
  • Male
  • Octreotide / therapeutic use*
  • Predictive Value of Tests
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Technetium Tc 99m Aggregated Albumin
  • Treatment Outcome

Substances

  • Gastrointestinal Agents
  • Radiopharmaceuticals
  • Technetium Tc 99m Aggregated Albumin
  • Octreotide

Supplementary concepts

  • Waldmann disease