Pediatric abdominal chylolymphatic cysts: Sneaky abdominal masqueraders.

Abstract

Chylolymphatic mesenteric cysts of the abdomen is a rare differential for cystic tumors, more so in the pediatric age group, and they have various clinical presentations. There have been very few cases reported worldwide. To the best of our knowledge, a multicystic chylolymphatic cyst of the abdomen as demonstrated below is the first reported occurrence worldwide in the pediatric age group. We herein report the case of a 1-year-old who presented to us with gradual distension of the abdomen for 4 months with occasional episodes of vomiting and a lobulated cystic abdominal mass on palpation. He was mistakenly treated with anti-tuberculous treatment for suspected loculated ascites. The imaging revealed a multiloculated mass in the abdomen in close relation to the small bowel. He was also worked up for tuberculosis, and the findings were negative. Laparotomy revealed multiple cysts closely applied to the jejunum, starting at 4 cm from the duodenojejunal flexure, which was resected and anastomosed. To the best of our knowledge, this is the first reported case of an abdominal chylolymphatic cyst occurring as a chain of multiple cysts in the pediatric age group, and we want to emphasize the importance of further imaging in a case of suspected loculated tuberculous ascites as this is a differential diagnosis with a treatable surgical option. Surgical excision of these cysts should be done in toto as an individual excision of each of these cysts in an attempt to preserve the bowel length may end up jeopardizing the blood supply of the affected bowel.