Chylolymphatic cyst of the greater omentum presenting as abdominoscrotal swelling in a child
A 5-year-old male child presented with left scrotal swelling and abdominal distension. His mother had noted a painless left scrotal swelling since birth and it was gradually increasing in size. She also noticed increasing abdominal girth for approximately 2 years. There was no history of trauma. Growth and development were otherwise normal, as were his appetite and feeding habits. Bowel and micturition habits were also normal. The family history was unremarkable. The patient was not on any medication and had no known allergy. On examination, his abdomen was hugely distended. A soft, cystic lump was palpable involving left and central part of the abdomen. Shifting dullness was absent. The scrotum was hugely enlarged and right testis could be felt separately from the swelling but not the left testis. It was not possible to get above the swelling on the left side. The swelling was oblong in shape, cystic, irreducible, and nontranslucent. Cross fluctuation with abdominal lump was absent.\nRoutine blood tests were within normal limits. An ultrasound examination was performed, and it showed septated ascites and left hydrocele. Contrast Enhanched Computed Tomography showed huge septated cystic lesion [] filling whole of the left and central part of the abdominal cavity pushing away the bowel anteriorly and posteriorly. The scrotal and abdominal swellings communicated in the left inguinal region. Both the testes were visible in the scrotum. With these clinical and imaging findings, a provisional diagnosis of abdominoscrotal lymphatic cyst was made.\nThe patient underwent laparotomy through an oblique left lower abdominal incision. Initially, the retroperitoneal space was explored. As we could not see the swelling, the peritoneum was opened to find a huge, soft cystic lesion [] arising from the greater omentum was identified. The cyst was opened and drained thin hemorrhagic fluid. It was multilocular and the lower pole of the cyst was seen going inside the left internal inguinal ring. With slight traction, the part of the cystic swelling lying in the scrotum could be delivered. Approximately, 900 mL of fluid was drained. The cyst was excised completely along with adjacent omentum. The internal inguinal ring was closed with a purse string suture. A drain was placed in the peritoneal cavity and the abdomen was closed in layers. Postoperative period was uneventful. The abdominal drain was removed on the 2nd postoperative day and he was discharged on the 3rd postoperative day. Histopathological examination of the cyst demonstrated features of chylolymphatic cyst [].