| Summary: | Acute abdominal pain is a frequently encountered symptom, often indicating a life-threatening, underlying medical condition. Abdominal pain may be caused by peritonitis, usually due to perforate appendicitis, may cause sepsis that can progress to septic shock. A 5-year 8-month-old boy presented to the emergency ward diagnosed with septic shock. He had felt low-grade fever and abdominal discomfort for 5 days in duration. At admission he looked severely ill, hypotensive and tachycardia with narrow pulse pressure. Abdomen was tender on palpation and peritoneal sign was found on the patient. Skin mottling was found with cold extremities. An initial management of septic shock was done. Leukocytosis and high serum C-reactive protein was found. Dengue and typhoid serology were negative. Abdominal radiography, ultrasonography, and CT-Scan with contrast identified several loculated ascites. Surgical exploration found intracystic hemorrhage and multicystic mass rupture within the greater omentum adjacent to the jejunum and ileum. The appendix was dilated and perforated. Cyst resection and appendectomy were performed. Histopathologic examination confirmed acute transmural appendicitis with concurrent cystic lymphangioma of the omentum. Enterococcus faecalis was identified from blood and intra-abdominal culture. Intraabdominal cystic lymphangioma is a rare and possible differential diagnosis in a child presenting with acute abdominal pain.
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