Laparoscopic Excision of Large Intra-Abdominal Cysts in Children: Needle Hitch Technique

Giant Intraabdominal Lymphangioma in a Pediatric Patient-A Challenging Diagnosis

Introduction: Intra-abdominal cystic formations represent heterogeneous pathologies with varied localization and clinical manifestation. The first challenge of a giant intra-abdominal cystic lesion is identifying the organ of origin. The clinical presentation of intra-abdominal cystic lesions varies from acute manifestations to non-specific symptoms or accidental discovery. Case presentation: A 2-year-old girl presents to the emergency unit with a fever of 38.5 Celsius, loss of appetite, and apathy. The investigations showed a gigantic intra-abdominal mass whose organ belonging could not be specified. Postoperatively, a giant mesenteric lymphangioma was evident, which was completely excised. Discussion: Giant cystic formations modify the anatomical reports and become space-replacing formations, and the starting point is even more challenging to assess preoperatively. Nevertheless, the careful evaluation of the characteristics of the formation, the effect on the adjacent organs, the age of the patient, and the clinical picture can provide elements of differential diagnosis. The stated purpose of this work is to systematize intra-abdominal lesions according to the organ of origin and to make the preoperative diagnosis of an intra-abdominal cystic lesion in the pediatric patient easy to perform starting from the presented case.

Recurrence of abdominal distension due to fluid accumulation in a child: Ascites or a cyst?

Background

Abdominal distension in children can be caused by fluid accumulation due to ascites or large cysts.

Case Presentation

A 25-month-old girl was brought to the pediatric gastroenterology clinic with the chief complaint of nontraumatic acute abdominal pain. She had undergone paracentesis last year with a diagnosis of suspected ascites in another medical clinic. Moreover, a CT scan following paracentesis was reported to be normal. After a few months, she gradually developed abdominal distension again. Diagnostic evaluations along with biochemical parameters and imaging strongly suggested the presence of a cyst. The large mesenteric cyst was totally removed by surgery.

Conclusion

In conclusion, in the face of recurrence of abdominal fluid accumulation, mesenteric cysts should be considered despite the fact that abdominal CT scan is normal after paracentesis.

Omental Cyst Presenting as an Acute Abdomen in a Pediatric Patient: A Case Report

Background

Omental cysts are the rarest forms of intra-abdominal cystic lesions. They are usually asymptomatic but can also present as acute abdomen. The presentation is confusing in some cases, which may result in mismanagement, added costs, and trouble for the patient. A pre-operative diagnosis is challenging, especially in resource-limited settings, and requires a high level of suspicion and a cautious approach during emergency exploratory laparotomy to avoid complications.

Case Details

This is a 4 year old male child who presented with high grade fever, vomiting, and abdominal pain of 2 days duration. He was tachypneic, tachycardic, and had diffuse abdominal tenderness. Emergency laparotomy revealed a large cyst with hemorrhagic content. Complete removal of the cyst was done, and the patient was discharged after improvement on the third post-operative day.

Conclusion

Omental cysts are rare in children and have varieties of presentations. Even though preoperative diagnosis is challenging, esspecially in resource-limited settings, clinicians should consider omental cysts in a child presenting with an acute abdomen. It is important for surgeons to consider omental cysts when carrying out emergency laparotomy for an unidentified abdominal condition.