Massive unilocular intraabdominal cysts in children are rare. Alimentary tract duplications can present diagnostic and therapeutic difficulties. Although they can occur anywhere from the mouth to the anus, they are commonly seen in relation to the ileum. We herein present an unusual case of duplication cyst itself occupying virtually all of the available intraabdominal volume. It appeared to be an enteric duplication cyst of ileal origin.
A 3-month-old girl was admitted to our hospital for investigation of progressive abdominal distension and biliary vomiting. Plain radiography of the abdomen showed normal air-fluid level in the stomach and paucity of gases in rest of the abdomen. Magnetic resonance imaging showed a huge, homogenous cyst extending from the xiphisternum down to the pelvis. The cyst was excised completely. Macroscopic examination and histologic findings confirmed the diagnosis of a huge enteric duplication cyst arising from the ileum.
Enteric duplication cyst should be considered in a patient with an abdominal cystic mass. Radiologist must take into account patient age, clinical parameters, and imaging findings to identify the likely etiology of a cystic mass.
abdominal cystic masses; enteric duplication cyst; magnetic resonance imaging; plain radiography
A 21 day old male child presented with non bilious vomiting and abdominal mass.
This case is reported because pyloroduodenal duplication cysts are an extremely rare congenital anomaly, whose clinical presentation often mimics those of hypertrophic pyloric stenosis. Ultrasound examination showed cystic mass at pyloric region and barium study was suggestive of extrinsic mass compressing the pyloric region. A laparotomy, a tense cystic mass was present at the pyloroduodenal junction (PDC) which was resected and end to end anastomosis was done. Patients followed an uneventful recovery and doing well.
The clinical and radiological analysis can reveal configurational changes consistent with a large extrinsic mass rather than muscular hypertrophy and can lead to accurate preoperative diagnosis.
Duplication cysts (DCs) of alimentary tract are rare congenital malformations. They are firmly attached to the wall of the gastrointestinal tract and they are supplied by surrounding mesenteric blood vessels. More than 80% of cases occur before the age of two years and only a minority of cases present in adulthood. “Completely isolated duplication” of the alimentary tract is an extremely rare variety of gastrointestinal duplications. They have gastrointestinal epithelial and wall characteristics without an anatomic association with the alimentary tract. Their main characteristic is that they have their own blood supply. A 20-year-old male was admitted to our department with symptoms persisting for a period of one week prior to admission, which included abdominal pain, fever, and a palpable abdominal mass. CT revealed an unexplained intraperitoneal abscess. This case represents a rare clinical example of infected isolated duplication cyst managed with percutaneous drainage and surgical excision of the cyst 3 weeks later. To the best of our knowledge, this is the first reported case to use this approach.
Gastric duplication cysts are rare variety of gastrointestinal duplications. Sometimes they may present with complications like hemorrhage, infection, perforation, volvulus, intussusception and rarely neoplastic changes in the gastric duplication cyst. We present one and half year old male child who developed sudden abdominal distension with pain and fever for two days. Ultrasound revealed a cystic mass in the hypochondrium and epigastric regions. On exploration an infected and perforated gastric duplication cyst was found. Surgical excision of most part of cyst wall with mucosal stripping of the rest was performed. Histopathology confirmed the diagnosis of gastric duplication cyst. Early surgical intervention can result in good outcome.
Gastric duplication cyst; Acute abdomen; Peritonitis
Duplications of the alimentary tract are very rare. A one-month-old female presented with symptoms of anorexia, vomiting and continuous watery diarrhea. The plain abdominal radiograph showed thickened intestinal wall and signs of small bowel obstruction. The fevers, vomiting, and continuous wartery diarrhea persisted despite antibiotics, and worsened. The patient failed to respond to medical managements, 27 hours after admission, the patient died due to multiple organ failures. The autopsy was performed, small bowel obstruction due to an ileocecal duplication cyst (3 × 3 cm) was recognized. The ileocecal duplication cyst was attached to the ileum which was changed edematous and necrotic. This potential diagnosis should be borne in mind for a patient who complains of abdominal symptoms with an unknown cause, and duplication cyst should be recognized as a fatal cause in infant.
sudden unexpected death; small bowel obstruction; ileocecal duplication cyst
Enteric duplications are rare congenital anomalies of the digestive tract that can occur anywhere along its length, with the majority being found in the small intestine. The duodenum is the least common site. Almost all symptomatic duodenal duplications present early in life with abdominal pain and pancreatitis. To the best of our knowledge this is the first described case of a perforated tubular duodenal duplication in an elderly adult.
PRESENTATION OF CASE
We present a case of a perforated tubular duodenal duplication in an elderly woman. She presented with diffuse abdominal pain, fever, and tachycardia. Emergent exploratory laparotomy revealed a perforated duodenal duplication. Excision of the duodenal duplication and primary closure of the defect was performed successfully. The patient recovered well.
Enteric duplications are poorly understood anomalies of embryonic development. They can be cystic or tubular dorsal enteric remnants lying in communication with the alimentary tract that are distinct from diverticula. A tubular duodenal duplication is exceedingly rare, and this case is made even more notable in that such an anomaly presented with sepsis and occurred in a 79 year old woman. We are unsure why the duplication ruptured. To the best of our knowledge this case represents the first report of a ruptured tubular duodenal duplication in an elderly adult.
This is a very rare occurrence and has never been described in an elderly patient before. Excision and primary closure led to a good outcome.
Duplication; Duodenum; Perforation; Duodenal; Elderly; Abdomen
Duplication cysts are rare gastrointestinal congenital abnormalities and can occur anywhere within the gastrointestinal tract. Duplication cysts are firmly attached to or share the wall of the alimentary tract and have a common blood supply with the adjacent segment of the bowel. Completely isolated duplication cysts are an extremely rare variety of gastrointestinal duplications with their own exclusive blood supply, and they do not communicate with the intestine. These cysts are usually diagnosed during early childhood, and very rarely detected in adults, mostly incidentally, due to a lack of symptoms. A 28-year-old male was admitted to our hospital with a chief complaint of lower abdominal pain and distention and a palpable mass for 1 month. Based upon computed tomography and sonographic findings, a small bowel duplication cyst was tentatively diagnosed. The cyst had no connection to the gastrointestinal tract. Herein we report the case of a noncommunicating isolated ileal duplication cyst in an adult. Resection of the cyst was performed safely without requiring bowel resection.
Duplication cysts are congenital cystic malformation of the alimentary tract consisting of a duplication of the segment to which it is adjacent. It can occur anywhere from mouth to anus. Oesophageal duplication cysts comprise 4% of the same. Of these, total intra-abdominal oesophageal duplication cysts are extremely rare. On review of literature, only 3 case reports of total intra-abdominal oesophageal duplication managed laparoscopically are found. All these cases were adults. We report the first paediatric case of intra-abdominal oesophageal duplication cyst excised laparoscopically.
Duplication cyst; oesophageal; laparoscopy
About 10% to 15% of all duplication cysts in the alimentary tract are esophageal. Esophageal duplication cysts are intimately attached to the alimentary tract, are lined by mucous membrane and have smooth muscle. This paper describes a 2-year-old child who presented with symptoms of progressive respiratory distress. A diagnosis of esophageal duplication cyst was made. At surgery a low cervical incision was made and the sternal manubrium split, thereby providing adequate exposure. The cyst was then removed. The most useful investigations were chest roentgenography and barium esophagography. Computerized tomography showed a small, round foreign body in the middle of the cyst that was subsequently found to be a bingo chip. Communication between the cyst and the esophagus was not obvious at the time of surgery and had not been demonstrated by barium esophagography. When complete excision of the cyst is not possible because of inflammatory reaction all the mucosa must be removed to prevent recurrence. Careful postoperative respiratory support and broad-spectrum antibiotic therapy are recommended.
A 4-year-old girl presented with non-bilious vomiting and loss of appetite and weight. At laparotomy, a non-communicating pyloroduodenal duplication cyst was present. Subtotal excision of the cyst and cauterization of the mucosal lining of the common wall was performed. The post-operative recovery was uneventful.
Gastric duplication; gastric outlet obstruction; pyloroduodenal duplication
Background. Duplication of the alimentary tract is a rare congenital anomaly. Gastric duplication cysts (GDCs) represent 4% of all alimentary tract duplications, and approximately 67% manifest within the first year of life. Duplication cysts in adults are generally encountered as incidental findings at endoscopy or laparotomy. Herein, we report two rare cases of symptomatic GDC presenting in adults. Case 1. A 27-year-old male presented with a five-month history of back pain. Exam revealed mild epigastric tenderness with a vague palpable mass in left upper abdomen. CT scan showed 8 × 7.4 × 6 cm homogenous, nonseptated cystic mass posterosuperior to pancreatic tail. On laparotomy, a cystic mass measuring 11 × 8 cm was found, which was densely adherent to posterior wall of stomach suggestive of GDC. Case 2. A 28-year-old woman presented with epigastric pain associated with vomiting for 2 months. Exam revealed mild epigastric tenderness. CT scan showed four cystic lesions in the medial wall of distal stomach measuring approximately one cm each suggestive of duplication cysts. Exploratory laparotomy with antrectomy and truncal vagotomy with Billroth II reconstruction were performed. Pathology in both patients was diagnostic of GDC. Conclusion. GDC is a rare anomaly, and its presentation in adults is even rarer.
Alimentary tract duplications are rare congenital anomalies. The presentation depends on their anatomical location, size and other characteristics. The most common variety is small bowel cystic duplication. We report a case of an eight years old girl who presented with recurrent abdominal pain and melena. Radioisotope technetium scan showed increased uptake of tracer in right lower abdomen and a diagnosis of Meckel’s diverticulum made. At surgery a cystic, communicating, ileal duplication found which was resected along with adjacent gut. It is thus reiterated that while investigating children with recurrent abdominal pain and melena, gut duplications must be included in the differential diagnosis.
Alimentary tract duplications; Pain abdomen; Melena
Intestinal duplication is an uncommon congenital condition in young adults. A 25-year-old man complained of chronic, intermittent abdominal pain for 3 years following previous appendectomy for the treatment of suspected appendicitis. Abdominal discomfort and pain, suggestive of intestinal obstruction, recurred after operation. A tubular mass was palpable in the right lower quadrant. Computed tomography enterography scan identified suspicious intestinal intussusception, while Tc-99m pertechnetate scintigraphy revealed a cluster of strip-like abnormal radioactivity in the right lower quadrant. On exploratory laparotomy, a tubular-shaped ileal duplication cyst was found arising from the mesenteric margin of the native ileal segment located 15 cm proximal to the ileocecal valve. Ileectomy was performed along with the removal of the duplication disease, and the end-to-end anastomosis was done to restore the gastrointestinal tract continuity. Pathological examination showed ileal duplication with ectopic gastric mucosa. The patient experienced an eventless postoperative recovery and remained asymptomatic within 2 years of postoperative follow-up.
Ileal duplication cyst; Adulthood; Computed tomography enterography; Tc-99m pertechnetate scintigraphy
Intestinal duplications are rare developmental anomalies that can occur anywhere along the gastrointestinal tract. Rectal duplication cysts account for approximately 4% of all duplication cysts. They usually present in childhood with symptoms of mass effect, local infection or more rarely with rectal bleeding from ectopic gastric mucosa.
PRESENTATION OF CASE
A 26 year old male presented with a history of bright red blood per rectum. On examination a mucosal defect with an associated cavity adjacent to the rectum was identified. This was confirmed with rigid proctoscopy and CT scan imaging. A complete transanal excision was performed.
Rectal duplication cysts are more common in pediatric patients. They more frequently present with symptoms of mass effect or local infection than with rectal bleeding. In adult patients they are a rare cause of rectal bleeding. Definitive treatment is with surgical excision. A transanal, transcoccygeal, posterior sagittal or a combined abdominoperineal approach may be used depending on anatomic characteristics of the duplication cyst.
We present a rare case of a rectal duplication cyst presenting in adulthood with rectal bleeding, managed with transanal excision.
Rectal duplication cyst; Adult; Rectal bleeding
Duplication of alimentary tract is one of the rare congenital anomalies. A case of duplication cyst of the cecum, presented in the 3rd month of life, as intestinal obstruction. Excision of the cyst along with cecum and appendix was done. The child had an uneventful postoperative recovery following ileoascending anastomosis.
Caecal duplication cyst; Intestinal obstruction
A 21-year-old male with developmental delay presented with abdominal pain of two days' duration. He was afebrile and his abdomen was soft with mild diffuse tenderness. There were no peritoneal signs. Plain x-ray demonstrated a large air-filled structure in the right upper quadrant. Computed tomography of the abdomen revealed a 9 × 8 cm structure adjacent to the hepatic flexure containing an air-fluid level. It did not contain oral contrast and had no apparent communication with the colon. At operation, the cystic lesion was identified as a duplication cyst of the sigmoid colon that was adherent to the right upper quadrant. The cyst was excised with a segment of the sigmoid colon and a stapled colo-colostomy was performed. Recovery was uneventful. Final pathology was consistent with a duplication cyst of the sigmoid colon. The cyst was attached to the colon but did not communicate with the lumen.
This report describes a rare case of adenocarcinoma arising from a gastric duplication cyst, with invasion to the stomach wall, in a 40 year old Japanese man. A cystic lesion was found between the stomach and the spleen. The cyst had a well circumscribed smooth muscle layer, corresponding to the muscularis propria of the stomach and the mucosa of the alimentary tract. A well differentiated adenocarcinoma was found within the duplication cyst, invading its serosa. Well differentiated adenocarcinoma was independently found in the fundus of the stomach; the tumour of the cyst was connected by fibrous tissue. Microscopically, there was neither adenocarcinoma in situ nor precancerous lesions, such as epithelial dysplasia, suggesting that the carcinoma derived from a gastric duplication cyst that invaded the stomach. Duplication cysts should be included in the differential diagnosis of cystic masses of the gastrointestinal tract, and the possibility of malignancy within these cysts should be considered.
gastric duplication cyst; adenocarcinoma; gastrointestinal duplication
Duodenal duplication cyst is a rare anomaly, totaling only 4% to 12% of gastrointestinal duplications, and is usually encountered during infancy or in early childhood. Most are commonly located posterior to the first or second portion of the duodenum. Presenting signs and symptoms include vomiting, decreased oral intake, periumbilical tenderness, abdominal distention, obstructive jaundice, acute pancreatitis, and gastrointestinal bleeding. The traditional treatment of a duodenal duplication cyst has been complete surgical resection, but very few cases of endoscopic treatment have been reported in the literature. Here, we report a case of duodenal duplication cyst that was manifested by a duodenal polyp.
Duodenum; Duplication cyst; Endoscopic resection
In an infant presenting with a mass in the abdomen and non-bilious vomiting,
duplication cyst needs to be considered in the list of differential diagnoses.
Gastric duplication cyst is an uncommon occurrence in children. Diagnosis is
based on clinical findings and imaging features. Surgical excision is safe and
offers a complete cure. The literature recommends excision even in asymptomatic
cases due to isolated reports of malignancy arising in the duplication cyst in
abdominal neoplasms; cyst; differential diagnosis; gastrointestinal tract; paediatrics; vomiting
Congenital anomalies are a rare cause of pancreatitis in adults. Gastric duplications are the least common duplication of the gastrointestinal tract and are even more uncommon in the setting of a duplicate pancreas.
PRESENTATION OF CASE
This manuscript contains a case report and review of the literature of an adult who presented with recurrent pancreatitis and was found to have a gastric duplication cyst that communicated with a duplicate pancreas. The study aim is to alert practitioners to the duplicate anomaly and recommend appropriate therapy.
Combined gastric and pancreatic duplications usually occur in young females with nonspecific, recurrent abdominal pain. This combined duplication can result in pancreatitis when the gastric duplication is contiguous with the stomach. Heightened awareness of the condition, appropriate diagnostics with accurate interpretation and a minimalist approach to resection are warranted.
Recurrent abdominal pain and pancreatitis in young adults devoid of risk factors should lead to consideration of congenital anomalies. Not all cysts near the pancreas and stomach are pseudocysts. ECRP and abdominal CT/MRI provide critical diagnostic information. This dual anomaly is best treated by simple excision of the gastric duplication and heterotopic pancreas.
Gastric duplication; Pancreas duplication; Pancreatitis
Alimentary tract duplications are rare congenital anomalies. They most often become symptomatic in childhood and rarely undergo malignant transformation. Pseudomyxoma peritonei (PMP) is an equally uncommon condition, most frequently originating from a primary appendiceal mucinous neoplasm. We report an extremely unusual case of PMP arising from an intestinal duplication. A 67-year-old woman presented with vague upper abdominal pain, and, unexpectedly, explorative laparoscopy revealed diffuse jelly-like peritoneal implants. The histopathological diagnosis of a low-grade PMP or “disseminated peritoneal adenomucinosis” was made. At that moment, no primary tumor was found. During later surgery, a cystic lesion located in the mesentery of the small bowel could be resected. Histologically, the cyst wall clearly showed the concentric layering of a normal bowel wall. The mucosa, however, displayed a diffuse low-grade villous adenoma. We concluded that this histological picture was most consistent with a small intestinal duplication, containing a low-grade villous adenoma. The adenoma caused a mucocele, which subsequently leaked or ruptured, giving rise to noninvasive mucinous peritoneal implants or low-grade PMP, also known as “disseminated peritoneal adenomucinosis” (DPAM).
Duodenal duplication cysts are benign rare congenital anomalies reported mainly in the pediatric population, but seldom in adults. Symptoms depend on the type and location and can present as abdominal pain, distension, dysphagia or dyspepsia. They have been reported to be responsible for duodenal obstruction, pancreatitis and, in rare cases, gastrointestinal bleeding. We present a case of a duodenal duplication cyst in a 43-year-old man presenting as melena. Initial gastroduodenoscopy and colonoscopy did not reveal any bleeding focus. However, the patient began passing melena after 3 d, with an acute decrease in hemoglobin levels. Subsequent studies revealed a duplication cyst in the second portion of the duodenum which was surgically resected. Histology revealed a duodenal duplication cyst consisting of intestinal mucosa. There was no further bleeding and the patient recovered completely. In rare cases, duodenal duplication cysts might cause gastrointestinal bleeding and should be included in the differential diagnosis.
Gastrointestinal hemorrhage; Duodenum; Duplication
Gastrointestinal tract duplications are rare congenital malformations that may occur anywhere in the alimentary tract from the mouth to the anus, and vary greatly in presentation, size, location, and especially in symptoms. We present a case of an infected spherical colonic duplication, in a 20-day-old baby, located at the splenic flexure of the colon. The prominent symptom was acute abdomen, accompanied by bilious vomiting, intestinal obstruction, and high fever. We present this case, due to atypical clinical presentation and the inability of the imaging modality to establish the diagnosis preoperatively.
We report a case of an 8-month-old, asymptomatic child who was incidentally detected to have two cystic structures in the abdomen. Surgical exploration revealed a gastric and pancreatic duplication cyst along with a blind-ending duplication of the right ureter. Excision of the duplications was relatively straightforward, and the child made an uneventful recovery. This constellation of duplications has not been reported before.
Gastrointestinal duplications; pancreatic duplications; ureteral atresia; ureteric duplication
Choledochal cyst is a rare condition characterised by congenital dilatation of the biliary tree. Commonly seen in the oriental countries, patients usually present with a varying combination of abdominal pain, jaundice, lump or cholangitis. Untreated patients or incomplete removal of the cysts usually leads to portal hypertension and cholangiocarcinoma. Almost one-third of the cases have intrahepatic cyst, making complete cyst excision often impossible. We are reporting a 9-year-old girl with type IVa choledochal cyst presented to us with recurrent pain abdomen and intermittent jaundice for 1 year. Excision of extrahepatic cyst, left hepatectomy, mucosectomy of the residual cyst wall of right lobe of the liver and a wide bilioenteric anastomosis was done. Patients followed up with an magnetic resonance cholangiopancreatography (MRCP) 2 months later showed shrinkage of the residual cyst and good bile drainage. Mucosectomy of intrahepatic cyst may prevent recurrent cholangitis, calculus formation and cholangiocarcinoma in the long run.
Type IVa choledochal cyst; Hepatectomy; Mucosectomy