Abdominal cystic lymphangiomas are uncommon congenital benign tumors [1
]. The mean age at presentation is 2.2 years. The study performed by Konen et al [2
] showed that the male-to-female ratio is 5:2. Etiology [3
] may be benign proliferations of ectopic lymphatics that lack communication with the normal lymphatic system. Cysts are thought to arise from lymphatic spaces associated with the embryonic retroperitoneal lymph sac. Failure of the embryonic lymph channels to join the venous system, trauma, neoplasia and degeneration of lymph node are some proposed etiologies.
Clinical presentation [4
] may be chronic in which there is gradual distention in abdomen with or with out pain. It may present in acute form in which there is acute pain, distention, fever, vomiting and peritonitis. There may be features of small bowel obstruction which may occur by extrinsic luminal compression, by traction on the mesentery or by volvulus.
A well-circumscribed anechoic mass with posterior acoustic enhancement is a typical ultrasound presentation [5
]. CT scan shows well defined, thin walled multiseptate lesion and distinguished from ascites by the absence of bowel loop separation or fluid in the typical sites, such as the cul-de-sac [6
]. Complications [7
] are intestinal obstruction (most common), volvulus, hemorrhage into the cyst, infection, rupture, cystic torsion and obstruction of the urinary and biliary tract. Complete resection is the treatment [8
] of choice and has an excellent prognosis.
Although an abdominal lymphangioma is considered benign, it may become locally invasive. Therefore any involved organ must also be resected. Incomplete resection may lead to recurrence[8
]. If the patient was treated with marsupialization, closer follow-up for possible recurrence should be instituted. Otherwise, no long-term follow-up for surgical problems is necessary. The recurrence rate ranges from 0–13.6%. If cysts are discovered prenatally, intervention during early infancy is indicated to prevent potential complications such as obstruction and intestinal volvulus. In our patient the cyst was found in the greater omentum which was excised completely without bowel resection.