Laparoscopy in the management of a child with giant pseudocyst of the greater omentum

Abstract

Introduction . Greater omentum cysts found in children belong to a rare pathology occurring as frequent as 1:23000. During the majority of observations, they are diagnosed during an ultrasound examination and abdominal computed tomography. However, in some cases it is impossible to restore an organ from which a cyst can originate using visual non-invasive methods. Purpose . This paper presents a clinical case of surgical treatment of a 7-year-old child with giant pseudocyst of the greater omentum. Materials and methods . The patient complained of periodic pains in the abdomen and increased abdominal size. The diagnosis was made following an abdominal ultrasound examination when a giant liquid formation (200×180×220 mm) was found. Subsequent MRI and CT tests of the abdomen gave a view of a cystic formation which was allegedly a cystadenoma of the left ovary. A cystic formation occupying the entire abdominal cavity was detected during a laparoscopy. Puncture and aspiration of 2.7 L of serous and hemorrhagic liquid were performed. It was found out that the formation originated from the greater omentum. The greater omentum was resected within healthy tissues along the mesocolonic border and cystic membranes were removed via a separate incision. Conclusion . When diagnosing large cystic abdominal formations, a final diagnosis of organ origin can sometimes be established during laparoscopy only when endosurgical treatment could be done (in the presence of a respective technique and educated specialists).