Ileal duplication cyst.

Abstract

uptake in the right side of the pelvis. A sonographic cross section of the lesion revealed a cystic mass with a definable multilayered wall, including echogenic mucosa and hypoechoic submucosa/muscularis (Fig. iB). A real-time sonographic examination showed reproducible peristalsis of the mass (Fig. iC). Following excision, the mass was noted to be attached to the mesenteric side of the ileurn. On cut sections (Fig. 1D), a well-defined marginal ulcer was seen adjacent to a nipple of gastric mucosa protruding into the ileal lumen. Histopathologic review (Fig. i E) showed a nipple of gastric epithelium adjacent to ileal mucosa. The final pathologic diagnosis was ileal duplication cyst lined by gastric epithelium. The patient recovered uneventfully. Alimentary duplications are cystic or tubular structures attached to the mesenteric side of the gastrointestinal tract, often sharing a common smooth muscle wall and vascular supply with histologic features of a layered smooth muscle coat and gastrointestinal mucosal lining [1]. They may occur anywhere from the pharynx to the rectum, with approximately 33% arising in the foregut, 56% in the midgut, and ii% in the hindgut. The ileum is the single most common site (35%). Half of all alimentary duplications appear before i month of age, and typical clinical signs and symptoms include gastrointestinal hemorrhage, gastrointestinal obstruction from mass effect or intussusception, or abdominal pain. On barium examinations or imaging studies, a noncommunicating cystic mass with a gastrointestinal wall, as seen in this case, can be identified. A 99mTcpertechnetate scintigram of Meckel’s diverticulum will show gastric mucosa (present in up to 35% of enteric duplications [2]) in the bleeding ileal duplications. Intestinal hemorrhage, seen most commonly in children, is usually due to peptic ulceration of gastric mucosa (as in this case), intussusception, or pressure necrosis from the mass [3]. Intrinsic peristalsis of the mass, as identified in this case, has not been reported in duplication cysts or Meckel’s diverticula. Meckel’s diverticula can be distinguished from duplication cysts by demonstrating their separate blood supply from the vitelline artery (a branch of the superior mesenteric artery) and their origin from the antimesenteric border of the small intestine [4].