ABSTRACT
INTRODUCTION AND IMPORTANCE: Giant cystic lymphangioma was a congenital lymphatic system malformation. Although it is benign, it can cause some complications requiring prompt treatment. The selection of therapy was challenging because none of them is perfect. In this report, we presented a case of multiple giant cystic lymphangiomas in an infant treated with stepwise surgeries combined with intralesional bleomycin injection. CASE PRESENTATION: A two-day-old infant presented with multiple, soft, skin-colored tumors on the right side of the neck, thoracoabdominal region, axilla, and upper extremity which on pre-natal MRI appeared as heterogeneous masses with septate cystic components infiltrating upper chest cavity and compressing subclavian and carotid arteries. The patient was treated successfully with stepwise surgeries followed by intralesional bleomycin injections. CLINICAL DISCUSSION: Cystic lymphangioma is a benign malformation of lymphatic vessels with the neck and axillar region being the most common site. There are several options for treatment modalities. Surgery has been the mainstay of treatment, but other treatment modes are getting more popular. A combination of surgery and sclerotherapy has shown satisfying results. CONCLUSION: In large and infiltrative lymphangioma cases, staged surgery followed by intralesional bleomycin injection can be a treatment approach to minimize morbidity and mortality.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. CASE PRESENTATION: Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. CLINICAL DISCUSSION: Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. CONCLUSION: The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight.
