Merck Manual

Please confirm that you are a health care professional

honeypot link

Intestinal Lymphangiectasia


Atenodoro R. Ruiz, Jr.

, MD, The Medical City, Pasig City, Philippines

Last full review/revision Feb 2021| Content last modified Feb 2021
Click here for Patient Education
Topic Resources

Intestinal lymphangiectasia is a rare disorder characterized by obstruction or malformation of the intramucosal lymphatics of the small bowel. It primarily affects children and young adults. Symptoms include those of malabsorption, with edema and growth retardation. Diagnosis is by small-bowel biopsy. Treatment is usually supportive.

Malformation of the lymphatic system is congenital or acquired. Congenital cases usually manifest in children (typically diagnosed before age 3 years) and less frequently in adolescents or young adults. Males and females are equally affected. In acquired cases, the defect may be secondary to retroperitoneal fibrosis, constrictive pericarditis, pancreatitis, neoplastic tumors, and infiltrative disorders that block the lymphatics.

Impaired lymphatic drainage leads to increased pressure and leakage of lymph into the intestinal lumen. Impairment of chylomicron and lipoprotein absorption results in malabsorption of fats and protein. Because carbohydrates are not absorbed through the lymphatic system, their uptake is not impaired.

Symptoms and Signs of Intestinal Lymphangiectasia

Early manifestations of intestinal lymphangiectasia include massive and often asymmetric peripheral edema, intermittent diarrhea, nausea, vomiting, and abdominal pain. Some patients have mild to moderate steatorrhea (foul-smelling, pale, bulky, and greasy stools). Chylous pleural effusions (chylothorax) and chylous ascites may be present. Growth is retarded if onset is in the first decade of life.

Diagnosis of Intestinal Lymphangiectasia

  • Endoscopic small-bowel biopsy

  • Sometimes contrast lymphangiography

Diagnosis of intestinal lymphangiectasia usually requires endoscopic small-bowel biopsy, which shows marked dilation and ectasia of the mucosal and submucosal lymphatic vessels at the tips of the villi. Alternatively, contrast lymphangiography (injection of contrast material via the pedal lymphatics) can show abnormal intestinal lymphatics.

Laboratory abnormalities include lymphocytopenia and low levels of serum albumin, cholesterol, IgA, IgM, IgG, transferrin, and ceruloplasmin.

Barium studies may show thickened, nodular mucosal folds that resemble stacked coins. D-xylose absorption is normal. Intestinal protein loss can be shown by using chromium-51–labeled albumin.

Treatment of Intestinal Lymphangiectasia

  • Supportive care

  • Sometimes surgical resection or repair

Abnormal lymphatics cannot be corrected. Supportive treatment of intestinal lymphangiectasia includes a low-fat (< 30 g/day), high-protein diet containing medium-chain triglyceride supplements. Supplemental calcium and fat-soluble vitamins are given.

Intestinal resection or anastomosis of the abnormal lymphatics to the venous channels may be beneficial. Pleural effusions should be drained by thoracentesis.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Test your knowledge
Whipple Disease
Whipple disease predominantly affects white men 30 to 60 years of age. Affected patients may have subtle defects of cell-mediated immunity that predispose to infection with T. whipplei. Of the patients with this disease, approximately what percentage have a positive result on HLA-B27 test?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID