Intra-abdominal cystic lymphangiomas are rare benign malformations of the lymphatic system. Adult presentation is uncommon, and occurrence during pregnancy is exceptionally rare. Lesions arising from the omental bursa are particularly unusual and pose diagnostic and surgical challenges because of their deep location and proximity to major vascular structures [1–3]. A 31-year-old primigravida at 20 weeks gestation presented with progressive abdominal distension. Routine obstetric ultrasonography revealed a large multiloculated cystic mass occupying much of the abdominal cavity. Owing to the coexistence of fetal “Arnold–Chiari” malformation, medical termination of pregnancy (MTP) was performed at 22 weeks. Contrast-enhanced computed tomography demonstrated a well-defined, thin-walled, multiloculated hypodense lesion extending from the inferior border of the liver to the dome of the urinary bladder, displacing bowel loops and abutting major vessels, without solid components or calcification. Exploratory laparotomy revealed a 25 × 20 cm cystic lesion arising from the omental bursa, which was excised en-bloc with preservation of adjacent bowel and vascular structures. Histopathological examination (HPE) confirmed cystic lymphangioma. Cystic lymphangioma should be considered in differential diagnosis of large intra-abdominal cystic lesions encountered during pregnancy. Early recognition, careful imaging evaluation, and surgical planning can achieve excellent outcomes, even in anatomically complex locations.
