Toddler with giant omental cyst, profound anemia, and shock: case report and review of the literature

Abstract

Giant greater omental cysts with associated massive hemorrhage are rare. We encountered a 16-month-old boy with a four-day history of acute abdominal pain, distension, and paleness. Physical examination revealed a blood pressure of 74/27 mmHg. No well-defined masses were observed on abdominal palpation. The hemoglobin level on admission was 24 g/L. After initial resuscitation and blood transfusion, a computed tomography (CT) scan was performed, revealing a giant cystic mass with an intracystic hemorrhage. The diagnosis was confirmed via exploratory laparotomy, and the cyst, with the attached partial omentum was removed. Pathological findings revealed a simple cyst originating from the greater omentum. The patient recovered uneventfully and remained well during the two-year follow-up period. We reviewed the literature published over the last 27 years on cases of omental cysts to evaluate demographic characteristics, clinical presentations, complications, diagnostic tool options, and surgical approaches.

Omental Cyst With Torsion: A Rare Culprit of Pediatric Acute Abdomen

“…In the evaluation of intra-abdominal cystic lesions, sonography plays a pivotal role as a non-invasive and readily available imaging tool. It provides real-time visualization, aiding in distinguishing fluid-filled structures from solid masses and offering insights into the characteristics of the cyst [ 2 - 5 ]. Computed tomography scans provide detailed cross-sectional images, facilitating precise localization, characterization, and assessment of the cyst's relationship with adjacent structures.…”

“…Common differential considerations encompass cystic neoplasms, such as pancreatic cystic neoplasms or liver cystadenomas, as well as congenital cystic lesions like choledochal cysts or renal cysts. Additionally, infectious etiologies, such as abscesses or hydatid cysts, and inflammatory conditions like pseudocysts, should be considered [ 3 - 5 ].…”

“…Surgical excision stands as the primary and most widely accepted intervention, particularly for symptomatic or large cysts. The surgical approach may vary from laparoscopic to open methods, depending on the complexity of the cyst and the surgeon's expertise [ 5 ]. However, a conservative approach, including observation and periodic imaging, may be considered for asymptomatic or small cysts, especially in cases where surgery poses a higher risk.…”

“…While these cysts are generally benign, their occurrence in children, particularly when accompanied by torsion of the greater omentum, is a rare clinical occurrence. There is limited literature on pediatric cases involving omental cysts with torsion [ 2 - 5 ]. Despite the usual lack of symptoms in the majority of omental cysts, torsion of the greater omentum can result in acute abdominal pain, emphasizing the need for timely recognition and intervention [ 3 ].…”