Introduction
Omental lymphangiomas are rare vascular anomalies of benign nature. The
etiology remains a subject of controversy, but they are considered to
arise due to anomalies that occur during the normal embryogenic
developmental process of lymphatic vessels. They are thin-walled cystic
formations and only 5% of them originate from sites within the
abdomen(1). This lymphatic malformations mostly arise in the head and
neck as well as axillary reigon of neonates and adults (2).
This case report aims to highlight the uncommon site and age of clinical
presentation of cystic lymphangioma and discuss the diagnostic process,
and management strategies. The case report also shows the need for a
high index of suspicion and early diagnostic imaging for pediatric
patients who present with recurrent abdominal pain.
Case History/
examination
A 9-year-and-5-month-old male schooler came to Gondar University
Specialized Hospital with acute abdomen like symptom of sudden onset of
severe, sharp lower abdominal pain lasting 4 days and associated with
intermittent fever. Initially, the pain started in the left lower
abdomen and progressively involved the whole abdomen within one day,
making it difficult for him to walk. He also developed vomiting of
ingested matter which started a day prior to presentation. The patient
had previous history of recurrent bouts of acute abdominal pain which
started around the age of seven For which he visited nearby health
centers 6 times where he was investigated with complete blood count and
stool exams and recieved treatment for intestinal parasites with out any
siginficant improvement. He had no abdominal imaging done during those
times because the scan was deemed unnecessary by the treating
physicians.
Upon Physical Examination he was Acutely sick-looking and in pain,
otherwise conscious, not in respiratory distress, well-nourished. His
blood pressure was: 90/50 mmHg, pulse rate was 112 beats per minute,
respiratory rate 25 breath per minute and a fever of 38.3 degree
celcius. Upon Abdominal Examination bowel sounds were normal and on
Superficial Palpation, there was involuntary muscle rigidity and direct
tenderness over the left lower quadrant (LLQ) and rebound tenderness but
no superficial palpable mass. Upon Deep Palpation there was Smooth,
round, tense, tender, ill-defined 4 centimeter by 4 centimeter palpable
mass over LLQ extending to the left flank area. Mass was not bimanually
palpable. There was no organomegaly. Digital rectal examination was
normal.