Heterotopic duplication cysts

Abstract

Enteric duplication cysts are a rare finding, most commonly found in young children with many being seen on prenatal ultrasound. Gastric duplication cysts are a rare form of duplication cyst accounting for less than 10% of all duplication cysts, with the majority found in females. Rarely, these cysts can have clinically important ectopic tissues including gastric, duodenal, and pancreatic tissues, so can present with ectopic gastric ulcers and, very rarely, perforate or hemorrhage. We present a case report of two patients seen at Tufts Children's Hospital with a duplication cyst. The first patient presented with a heterotopic duplication cyst attached to the head of the pancreas with no communication with the alimentary tract and the second patient presented with a heterotopic duplication cyst attached to the tail of the pancreas, again with no communication with the alimentary tract, both consistent with gastric-type mucosa on pathological examination. We were unable to find any previously documented evidence of heterotopic duplication cysts that did not involve communication with the stomach, attachment via a common wall to the stomach, or a shared blood supply. Gastric duplication cysts are a rare form of duplication cyst in general, and rarely present with complications such as ulcers or cancer, but are favored for surgical management given the risks of mass effect or other symptoms as well as the rare risks for other complications including hemorrhage or erosion. Embryologically, the development of duplication cysts is thought to be related to the recanalization phase of the bowel lumen. Multiple management modalities have been described in the literature, with the most common being surgical resection if possible, or cystogastrostomy if unresectable. Both patients recovered well post-operatively and continue to be followed in clinic.