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 .