Foregut Derived Duplication Cyst Presenting as Abdominal Pain

Abstract

Purpose: Enteric duplication cysts are rare congenital malformations that can occur anywhere from the mouth to the anus. Cystic duplications are endothelium lined and share a common muscular wall and blood supply with the adjacent gastrointestinal tract. We present the unique case of a foregut derived duplication cyst presenting as abdominal pain and elevated inflammatory markers in an adult patient. Methods: A 26 year-old Caucasian female presented to our gastroenterology clinic with 3 weeks of constant, non-radiating, epigastric abdominal pain. She denied weight change, nausea, emesis or dysphagia and had no past medical or surgical history. Medications only included lansoprazole 30 mg daily started 2 weeks prior by her primary care physician which provided no relief. She had moderate tenderness to palpation in the epigastrium and an otherwise normal physical exam. Laboratory tests were significant for WBC of 11, 300, CRP of 40.2 mg/L, and gastrin level of 156 pg/mL. Upper endoscopy revealed mild antral erythema and biopsies were consistent with non-specific gastritis. An abdominal CT demonstrated a cystic structure anterior to the gastro-esophageal junction and posterior to the left hepatic lobe measuring 1.7 × 1.6 cm (Fig. 18). The patient was then referred for exploratory laparoscopy which showed a smooth mass protruding through the gastrohepatic ligament. The mass was removed and grossly appeared to be a 2.7 × 2.5 × 1.5 cm cyst. The histology was consistent with a foregut derived duplication cyst of either bronchogenic or esophageal origin. Two weeks post-operatively her symptoms had resolved and laboratory values had normalized. Results: This case is a unique presentation of a foregut derived duplication cyst presenting as epigastric abdominal pain and elevated inflammatory markers, suggesting that duplication cysts be included in the differential diagnosis of abdominal pain. Conclusion: As the potential complications of enteric duplications include gastrointestinal bleeding and rarely malignant transformation, the recognition of duplication cysts must lead to prompt surgical evaluation.Figure 1