Abstract
INTRODUCTION: Omental cysts are rare congenital lymphatic lesions in children, presenting as a palpable mass, abdominal distension, or acute abdomen. Complications include hemorrhage, rupture, and torsion. Diagnosis is challenging due to nonspecific symptoms, often requiring imaging. Surgical excision is the definitive treatment. This case highlights a unique presentation of a large hemorrhagic cyst, initially misdiagnosed as ascites. CASE PRESENTATION: An 8-month-old male presented with irritability for 1 week, abdominal distension, poor feeding, and no stools for 3 days. Examination revealed fever, tachycardia, pale appearance, and distended abdomen with shifting dullness. Investigations showed severe anemia, leukocytosis, and complex ascites on imaging. Surgical exploration identified a 25 × 15 cm hemorrhagic omental cyst, resected alongside herniotomy for a left inguinal hernia. Histopathology confirmed cystic lymphangioma. Recovery was uneventful, with normal follow-up ultrasound at 6 months. DISCUSSION: Omental cysts, rare in children, arise from ectopic lymphatic tissue and present variably as abdominal distension, pain, or intestinal obstruction. Misdiagnosed as ascites in this case, imaging often identifies cystic masses, though definitive diagnosis can be challenging. This infant's severe anemia was unusual, requiring pre- and postoperative transfusions. Treatment typically involves complete excision; here, open resection was chosen due to the cyst's size and hemorrhagic nature. This case underscores diagnostic challenges and emphasizes tailored management for rare abdominal cysts in children. CONCLUSION: This case highlights the diagnostic challenges of omental cysts in pediatric patients with atypical presentations. It underscores the importance of considering rare entities like omental cysts in acute abdomen cases and utilizing comprehensive diagnostic and surgical approaches.