Methods( differential diagnosis, investigations and treatment)
After admission to our pediatric ward he was investigated with Complete blood count and results showed Leukocytosis of 19,000/mm3 with neutophil percentage of 83%. Hemoglobin and platlet counts were normal. Liver and renal function tests were within refference ranges. Blood cultures were taken and later showed no organisms. Stool examination and urinalysis were non-revealing. Abdomino- pelvic sonographic scanning revealed 8.6x7.4x4cm left intraperitoneal multiloculated cystic lesions which pushes the bowel wall posteriorly and has multiple septa having color flow & echodebris Figure 1.
For further description of the cystic lesions abdominopelvic CT scan was done and it showed 12x7.7x5.3cm left mesenteric multiloculated cystic masses with thin wall and septa and no solid component is seen in the cystic mass Figure 2.
Ultrasound guided fine needle aspiration was taken from the cystic lesions and it showed Lymphocytes in cluster and dispersed form admixed with scattered mesothelial cells on protienacious background. No malignant cells were seen Figure 3.After consultation with the surgical team it was decide to do an explaratory laparatomy and excision of this benign looking mass as an elective after treating the possible infection.
The patient was then started on intravenous antibiotics empirically with ceftriaxone 75mg/kg IV daily and metronidazole 30mg/kg in three divided doses. After 48 hours of antibiotic therapy patient’s fever subsided and abdominal pain improved and after a week of therapy the pain and tenderness completely resolved but the palpable mass remained. He was then discharged and appointed for elective surgery after 2 weeks. Finally Exploratory laparotomy was done and a 4x8cm cystic mass arising from the omentum and adhered to distal transverse colon was resected and sample sent to histopathologic evaluation which later revealed adipose tissue containing differently sized cystically dilated lymphatic vessels lined by single flat endothelial cells containing protienacous secretory material which confirmed cystic omental lymphangioma Figure 4 .