Mesenteric cystic lymphangioma: a case report presenting with acute abdomen Los linfagiomas mesentéricos, en ocasiones asintomáticos, pueden presentarse como un hallazgo incidental en pruebas de imagen realizadas por otro motivo. El tumor también puede ser descubierto por sus complicaciones al comprimir estructuras vecinas, con signos inespecíficos de distensión abdominal o datos de abdomen agudo y obstrucción intestinal. Presentamos el caso de una niña de seis años de edad con clínica de abdomen agudo, compatible con cuadro de apendicitis aguda que no se descarta tras la realización de las pruebas de imagen. La laparotomía evidencia una malformación linfática intestinal con confirmación anatomopatológica de linfagioma quístico mesentérico. Mesenteric lymphangioma, sometimes asymptomatic, may course as an incidental finding on imaging performed for another reason. Sometimes the tumour is discovered because of its complications, by compressing neighbouring structures, with nonspecific signs of bloating or data of acute abdomen and obstruction. We report a 6 year old girl with symptoms of acute abdomen, resembling acute appendicitis not discarded with imaging tests. The laparotomy shows an intestinal lymphatic malformation with anatomo-pathological confirmation of cystic mesenteric lymphangioma.

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Adolescence is a vulnerable period for participation in a lot of risky behaviours, including the choking game, a dangerous practice whose consequences can be fatal. 1 We report a case of an 11-year-old boy referred for ataxia, disorientation and slurred speech. The boy had participated in a game based on bending over, hyperventilating and being hit in the chest. He suffered no loss of consciousness. He denied drug use. Neurological examination revealed incoherent speech, psychomotor agitation with alternating periods of lethargy and ataxia and an amnesia episode. The rest of the physical examination was normal (cranial nerves, pupillary response, strength and muscle tone). Blood count, biochemistry, toxic urine, brain scan, magnetic resonance imaging, and electroencephalogram were all normal. The child's neurological status improved rapidly, with full recovery of cognitive function after four hours of observation.The choking game is usually performed by teenagers and produces temporary interruption of cerebral perfusion. It can be achieved by different techniques such as bilateral neck compression, throttling themselves with ropes, or holding the breath and getting punched in the chest. The choking game seems to begin in groups. Individual practice is associated with increased risk of mortality. 2This patient was of particular interest because the mechanism used (holding the breath and getting punched in the chest) is not very common. Most cases reported in the literature describe bilateral neck compression as the principal mechanism to achieve self-induced hypocapnia.2 This entity can lead to cerebral vasoconstriction, increased cytokines 3 production and hypoxia. Syncope, seizures and cognitive deficits have been reported as immediate side effects. The differential diagnosis of these behaviours should include suicide and auto-erotic asphyxiation. 4 The suicide attempts often occur during late adolescence, while asphyxic games occur during early adolescence and often there is a history of previous attempts. The doctor should examine the patient looking for possible signs of self-injury such as marks on the neck or bloodshot eyes. These practices are becoming more common among adolescents. It is thought that many of the deaths result from engagement in this activity while alone. 2 The internet is a dangerous source of information about such games. Multidisciplinary work with psychologists and educators and participation in community prevention programs is required.