Omental Cysts in the Pediatric Population: Diagnostic Challenges and Surgical Outcomes

A BSTRACT Background: Omental cysts are rare intra-abdominal lymphatic malformations in children, accounting for approximately 2% of all intra-abdominal lymphatic lesions. Their embryological origin remains uncertain, and preoperative diagnosis is often challenging due to their nonspecific clinical and radiological features. This study aims to present our institutional experience with omental cysts in children and review current literature on their presentation, evaluation, and management. Materials and Methods: A retrospective review was conducted in our department between 2015 and 2024. Medical records of children who underwent surgery for omental cysts were analyzed for demographic data, presentation, imaging findings, operative details, histopathology, and outcomes. Results: Nine children (eight boys, one girl; median age 4 years) underwent omentectomy for omental cysts. Abdominal pain or distension were the most common presentations. Preoperative imaging was suggestive of omental origin in only one child, with others reported as mesenteric cysts or lymphatic malformations. The mean cyst diameter was 14 cm, with laparoscopy attempted in two children, while the rest underwent laparotomy. Histopathology confirmed benign lymphatic malformation in all patients. Postoperative recovery was uneventful, with no recurrence on follow-up for a minimum of 5 years. Conclusion: Omental cysts should be considered in the differential diagnosis of cystic abdominal lesions in children. Misdiagnosis as ascites or mesenteric cysts is common. Complete surgical excision through omentectomy remains the treatment of choice, offering excellent outcomes with minimal morbidity and negligible recurrence.