Abdominal Whispers of the Lymphatics: An Unusual Case of Paediatric Ileal Cystic Lymphangioma

Abstract Background: Ileal cystic lymphangiomas are uncommon benign lymphatic malformations, constituting a rare entity in the pediatric population. While typically located in the head and neck region, intra-abdominal presentations, particularly involving the ileal mesentery, are exceedingly rare, accounting for less than 1% of all lymphangiomas. Their clinical manifestation varies from incidental findings to acute abdominal emergencies and can mimic other intra-abdominal pathologies, often posing diagnostic challenges preoperatively. Case Details: We report a case of a 1-year-old male child presenting with intermittent severe abdominal pain. Imaging suggested a multiloculated cystic lesion with a clinical differential diagnosis of Meckel’s diverticulum or enteric duplication cyst. Intraoperative findings revealed an 8 × 4 cm nodular, multiloculated ileal mesenteric cyst associated with the ileum. Resection of the cyst along with ileal segment was performed followed by histopathological examination, which allowed us to make a definitive diagnosis. Conclusion: The rarity and uncommon presentation of mesenteric cystic lymphangiomas pose a diagnostic challenge. It can often be mistaken for other common causes of acute abdomen in paediatric patients, prompting unnecessary investigations and thus, should be considered in the differential diagnosis. Surgical intervention with complete resection is essential for timely management of patient.