Laparoscopic excision of giant omental cyst in a toddler: A case report

Giant omental cysts are rare, benign intra-abdominal lesions that may mimic ascites in children. This often leads to delay in the diagnosis and complications such as anemia. A 2-year-old girl presented with progressive gross abdominal distension and anemia. Physical examination revealed pallor and a distended abdomen with shifting dullness suggestive of ascites. Ultrasonography revealed a large, septated anechoic lesion with internal debris occupying the entire abdominal cavity, displacing all bowel loops. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis confirmed a well-encapsulated, non-enhancing, thin-walled cystic mass extending from the upper abdomen to the pelvis, displacing bowel loops to the left and compressing adjacent structures. We took her to the operating room for an exploratory laparoscopy. We first did a small supraumbilical incision and aspirated 500 cc of serosanguinous fluid from within the cyst. Once it was partially decompressed, we placed the ports and explored the abdomen. We found a large omental cyst with hemorrhagic fluid, which was the cause of the anemia. We proceeded to resect the cyst completely. The patient had an uneventful postoperative course and was discharged home on postoperative day two. Histopathology confirmed a lymphatic omental cyst. She remains asymptomatic at seven months of follow up. Giant omental cysts should be included in the differential diagnoses of children who develop gradual abdomen distension and have pseudo-ascites on imaging studies.