Background
Omental cysts are rare benign tumours. They occur due to malformation of the mesenteric lymphatic spaces which fail to communicate with the systemic lymphatic drainage. Diagnosis is challenging due to its rarity, indolent clinical progress, and non-specific clinical presentation in a normally well child. This case highlights the important clinical and radiological features of a giant omental cyst and a different perspective of management using combined ultrasound-guided percutaneous drainage with laparoscopic surgical excision.
Case presentation
We report a case of a giant omental cyst in a 3-year-old boy who presented with gradual abdominal distension over 3 months. He was initially treated for constipation. He had no abdominal pain or history of trauma. There was a non-shifting dullness and fluid thrill on abdominal examination. Persistent distention led to further imaging with ultrasound and computer tomography scan which revealed a giant cystic lesion occupying the whole abdominal cavity. A diagnosis of a giant omental cyst was made. The initial ultrasound-guided percutaneous drainage with gradual decompression of the cyst facilitated a safe and complete laparoscopic excision of the cyst. He recovered well after surgery.
Conclusion
Attention to important clinical and radiological features helps in the diagnosis of a giant omental cyst. Management with combined ultrasound-guided pigtail drainage and laparoscopic excision is safe and feasible.