IntroductionOmental lymphangiomas are rare vascular anomalies of benign nature. The etiology remains a subject of controversy, but they are considered to arise due to anomalies that occur during the normal embryogenic developmental process of lymphatic vessels. They are thin-walled cystic formations and only 5% of them originate from sites within the abdomen(1). This lymphatic malformations mostly arise in the head and neck as well as axillary reigon of neonates and adults (2).This case report aims to highlight the uncommon site and age of clinical presentation of cystic lymphangioma and discuss the diagnostic process, and management strategies. The case report also shows the need for a high index of suspicion and early diagnostic imaging for pediatric patients who present with recurrent abdominal pain.Case History/ examinationA 9-year-and-5-month-old male schooler came to Gondar University Specialized Hospital with acute abdomen like symptom of sudden onset of severe, sharp lower abdominal pain lasting 4 days and associated with intermittent fever. Initially, the pain started in the left lower abdomen and progressively involved the whole abdomen within one day, making it difficult for him to walk. He also developed vomiting of ingested matter which started a day prior to presentation. The patient had previous history of recurrent bouts of acute abdominal pain which started around the age of seven For which he visited nearby health centers 6 times where he was investigated with complete blood count and stool exams and recieved treatment for intestinal parasites with out any siginficant improvement. He had no abdominal imaging done during those times because the scan was deemed unnecessary by the treating physicians.Upon Physical Examination he was Acutely sick-looking and in pain, otherwise conscious, not in respiratory distress, well-nourished. His blood pressure was: 90/50 mmHg, pulse rate was 112 beats per minute, respiratory rate 25 breath per minute and a fever of 38.3 degree celcius. Upon Abdominal Examination bowel sounds were normal and on Superficial Palpation, there was involuntary muscle rigidity and direct tenderness over the left lower quadrant (LLQ) and rebound tenderness but no superficial palpable mass. Upon Deep Palpation there was Smooth, round, tense, tender, ill-defined 4 centimeter by 4 centimeter palpable mass over LLQ extending to the left flank area. Mass was not bimanually palpable. There was no organomegaly. Digital rectal examination was normal.