Duplication Cyst Research Articles

Respiratory epithelium in an enteric duplication cyst at the ileocecal valve

Abstract Although a duplication cyst of the alimentary tract is rare, it can occur anywhere in the alimentary tract. The inner epithelial lining of a duplication cyst mostly consists of the gastrointestinal epithelium. However, studies have reported that foregut duplication cysts can have a respiratory epithelium lining. It is rare, however, that respiratory epithelium covers midgut duplication cysts. We herein report an enteral duplication lined with respiratory epithelium, occurring in an 18-month-old girl. Our study highlights the need for more studies about the embryonic development of duplication cysts are needed.

Antenatally detected abdominal cyst: Does cyst size and nature determine postnatal symptoms and outcome?

BackgroundThe outcome of antenatally detected fetal intra-abdominal cysts is highly variable and challenging to predict. Antenatal ultrasound scans may be of value in predicting postnatal outcome. AimsTo report antenatal and postnatal course of fetal intra-abdominal cysts identified on antenatal ultrasound and establish the value of cyst dimensions for predicting outcome. Study designRetrospective observational study. SubjectsAll intra-abdominal cysts diagnosed in a single centre between 2013 and 2019. Outcome measuresCyst characteristics were recorded from radiological reports and postnatal diagnosis and outcomes documented. Growth characteristics were identified to distinguish different diagnosis. The maximum antenatal diameter of all cysts was identified and the best cut-off diameter to predict whether a cyst would persist postnatally or require surgery was identified. Best cut-off values were identified using Youden index. ResultsOf the 38 cysts identified on antenatal ultrasound, 24 (63%) persisted postnatally, 8 required surgery (21%) and 4 (11%) were not considered an intra-abdominal cyst postnatally. Ovarian cyst and duplication cyst may have different growth characteristics. In the prediction of cysts persisting postnatally, the area under the ROC curve (AUC) was 0.81 (95% CI, 0.66–0.95). Two cut off values were identified, 37.5 mm (50% sensitivity, specificity 100%, Youden's index 0.50) and 28.5 mm (sensitivity 65%, specificity 85%, Youden's index 0.50). In the prediction of surgery, no optimal diameter was found; AUC was 0.57 (95% CI, 0.34–0.81). ConclusionsMaximum antenatal cyst diameter is useful for the prediction of whether a cyst will persist postnatally but not for the prediction of surgery.

Su1315 DIFFERENCES IN THE DIAGNOSTIC YIELD BETWEEN EUS GUIDED FINE NEEDLE ASPIRATION (FNA) AND CORE BIOPSY (FNB) NEEDLES IN THE EVALUATION OF SUBEPITHELIAL LESIONS IN THE UPPER GASTROINTESTINAL TRACT

Establishing the histological diagnosis of subepithelial lesions (SEL) can be challenging. Even with rapid on-site cytology (ROSE), the diagnostic yield of EUS-FNA is low (40-65%) as core tissue is often required for ancillary studies such as immunohistochemistry (IHC) stain. Newer EUS-FNB needles are designed to obtain core tissue. This study aimed to compare the diagnostic yield of conventional FNA needles with the newer FNB needles in EUS guided tissue acquisition of SEL in the upper gastrointestinal tract. A prospectively collected database on all patients who were referred for EUS guided tissue acquisition of SEL in the upper GIT over 10 years was retrospectively reviewed. All EUS FNA/FNB procedures were performed without ROSE, and all material from the needles were placed into formalin for direct histological examination. The conventional group included specimens obtained from the 22G and 25G FNA needles and 25G reverse bevel needle. The FNB group included specimens from the 20G or 22G reverse bevel needle. The final diagnosis was based on either surgical specimens or from repeat FNA or FNB specimens with at least 6 months of clinical follow up. Specimens from 178 SEL taken from 166 patients, of which 100 were by FNB needles and 78 by FNA needles. There were no differences in demographics, lesion size and location of the lesion along the upper GIT tract between the group. The needle caliber used in each group as well as the diagnoses are summarized in Table 1. The diagnostic accuracy (86/100 vs 45/78; P<0.001) and ability of perform IHC (70/100 vs. 28/78; P<0.001) were substantially higher with FNB than FNA needles. The number of passes were similar in both groups (FNB=2.2± 0.8 vs 2.3±0.9; P=0.61). Of the non-diagnostic cases (n=47), 29 (61%) were smaller than 15mm, and were suspected to be lipomas (n=22), leiomyomas (n-18), pancreatic rest (n=5) or duplication cysts (n=2) based on EUS evaluation. No patients reported or were re-admitted due to pain, bleeding or perforation. Even with a similar number of needle passes and no ROSE, FNB needles achieved a higher diagnostic accuracy than FNA needles for EUS guided tissue acquisition of SEL, suggesting that FNB is the needle of choice for SEL.

Endoscopic submucosal dissection for gastric duplication cyst with heterotopic pancreas

Endoscopic submucosal dissection for gastric duplication cyst with heterotopic pancreas

A Rare Case of Cecal Duplication Cyst—a Case Report

Duplication cysts of the intestine are a rare clinical entity, usually diagnosed in infancy or childhood. Cecum is the least common site of gastrointestinal duplication cysts. We are presenting a case of non-communicating cecal duplication cyst in an adult female. The cyst was excised completely laparoscopically without compromising the blood supply to the adjacent cecum. Histopathology confirmed the diagnosis. Non-communicating cecal duplication cysts can be excised without compromising the vascularity but communicating duplication cysts mandate a segmental resection of the part of the bowel involved.

Acute inflammation of gastric duplication cyst in a toddler

Gastric duplication cysts (GDC) are rare types of gastrointestinal tract duplications, with various clinical presentations described in the literature. We herein report a 15 months old male toddler who presented to the emergency department with an acute abdomen and septic shock. After initial resuscitation, an upper gastrointestinal contrast study was done and showed a filling defect at the great gastric curvature. Surgical exploration revealed an inflamed gastric duplication cyst which was excised completely. This is a rare presentation of GDC. Accurate diagnosis of these cysts before resection is important. The clinical picture, diagnosis, and management options are described and compared to findings in the literature. In our best knowledge, this is the first case of gastric duplication which presents for the first time with inflammation in a toddler.

Pyloric duplication cyst with associated hypertrophic stenosis: A potential causal relationship

Abstract A 2-week-old baby girl was transferred to our facility with a suspected diagnosis hypertrophic pyloric stenosis. The diagnosis was confirmed by ultrasound, however an adjacent cystic structure was noted in close proximity to the pylorus concerning for a duplication cyst. Following the decision to address the hypertrophic pyloric stenosis first to allow growth and improve her nutritional status, she initially underwent an uneventful laparoscopic pyloromyotomy. However, due to continued postoperative oral intolerance she underwent an upper gastrointestinal series that was consistent with gastric outlet obstruction. She was taken for an open pyloric duplication cyst excision and has subsequently continued to grow and thrive.

Structural and perfusion magnetic resonance imaging of congenital lung malformations

BackgroundA radiation-free advanced imaging modality is desirable for investigating congenital thoracic malformations in young children.ObjectiveTo describe magnetic resonance imaging (MRI) findings of congenital bronchopulmonary foregut malformations and investigate the ability of lung MRI for their classification.Materials and methodsThis is a retrospective analysis of consecutive MRI examinations performed for suspected congenital lung anomalies in 39 children (median age: 3.8 months, range: 2 days–15 years). Morphological and perfusion findings were characterised on respiratory-gated fast spin echo and dynamic contrast-enhanced sequences obtained at 1.5 tesla. Abnormalities were classified independently by two readers and compared to an expert diagnosis based on pathology, surgery and/or other imaging.ResultsMain diagnoses included bronchopulmonary lesions in 33 patients, scimitar syndrome in 4 patients, pulmonary arteriovenous malformation and oesophageal duplication cyst in one patient each. Of 46 observed abnormalities, 44 (96%) were classified correctly with very good interobserver agreement (96% concordance rate). The 39 detected lung lesions included isolated overinflation (17/39, 44%), cystic pulmonary airway malformation (8/39, 21%), bronchopulmonary sequestration (7/39, 18%), bronchogenic cyst (4/39, 10%) and hybrid lesion (3/39, 8%). All lung lesions presented as perfusion defect at peak pulmonary enhancement. Non-cystic lesions showed a delayed peak (median delay: 2.8 s, interquartile range: 0.5 to 4.0 s) in relation to normal lung parenchyma.ConclusionA dedicated lung MRI protocol including respiratory compensated sequences, dynamic angiography and perfusion is able to reliably delineate parenchymal and vascular components of congenital bronchopulmonary foregut malformations. Therefore, MRI may be considered for comprehensive postnatal evaluation of congenital thoracic malformations.

Use of EndoFLIP to Diagnose a Duplication Cyst in a Child With Chronic Dysphagia.

Use of EndoFLIP to Diagnose a Duplication Cyst in a Child With Chronic Dysphagia.

Enteric duplication cyst in a neonate: A case report

Duplication cysts of intestine are rare congenital malformations formed due to some developmental anomaly of gastrointestinal tract during embryonic period. They can occur in any portion of the gastrointestinal tract but are more commonly seen in small intestine. They have a variable clinical presentation depending on the size, site and type, or they may remain asymptomatic. In most of the cases they are detected during infancy or early childhood and uncommon in adults. Antenatal ultrasound can detect the condition in fetus and helps in follow- ups subsequently. Treatment of asymptomatic case is controversial, however early intervention prevents complications. Herein, we share our experience of managing a neonate with enteric duplication cyst, detected antenatally.

Two infant cases of intraperitoneal arterial hemorrhage due to a duplication cyst: a case report

BackgroundIntraperitoneal arterial hemorrhage without trauma is extremely rare. We report two infant cases of intraperitoneal arterial hemorrhage due to intestinal duplication.Case presentationIn case 1, a 2-month-old girl experienced sudden intraperitoneal hemorrhage from the middle colic artery with no apparent trauma. Hemostasis was achieved with suturing of the hemorrhage point, but the cause of hemorrhage was still unknown. Computed tomography after the first operation revealed a duodenal duplication cyst and a pseudopancreatic cyst. Percutaneous drainage of the pseudopancreatic cyst was performed, and the contents had high pancreatic amylase. As the size of the duodenal duplication cyst also decreased with this drainage, we suspected that the duodenal duplication cyst was connected to the pseudopancreatic cyst and the arterial hemorrhage. We hypothesized that the pancreatic juice inside the duplication cyst leaked into the intraperitoneal cavity and caused rupture of the arterial wall. Therefore, marsupialization of the duodenal duplication was performed to evacuate the pancreatic juice contained in the cyst toward the native duodenum. The postoperative course was uneventful.In case 2, a 6-month-old boy experienced sudden intraperitoneal hemorrhage without trauma. The hemorrhage site was identified as the ileocecal artery, and hemostasis was achieved with sutures. Tissue near the hemorrhage point was biopsied, because the cause of arterial wall rupture was still unknown. The biopsied tissue was found to be intestinal mucosa. The patient had recurrent abdominal pain after the first operation, and computed tomography showed a duplication cyst located near the hemorrhage point. Therefore, we resected the intestinal duplication. Pathology results showed that the intestinal duplication contained intestinal mucosa, ectopic gastric mucosa, and pancreatic tissue. The postoperative course was uneventful.ConclusionIntraperitoneal arterial hemorrhage without trauma is an extremely rare condition, and identifying its cause is difficult. To our knowledge, this is the first report of intraperitoneal arterial hemorrhage due to intestinal duplication. In cases of unexplained intraperitoneal arterial hemorrhage in infants, intestinal duplication near the hemorrhage point should be suspected.

Duplication cyst of the esophagus: A rare congenital cause for vomiting and respiratory distress

A duplication cyst of the esophagus is the 2ndmost common congenital anomaly of the gastrointestinal tract. Although these benign cystic masses can be picked up routinely on a chest X-ray, patients may experience symptoms such as stridor or dysphagia corresponding to lesions within the neck or mediastinum. We present a rare case of a duplication cyst of esophagus in a 2-week-old female baby, which was surgically excised. Our aim in this case report is to raise awareness of this congenital disorder; especially when differential diagnoses such as acute respiratory distress syndrome (ARDS), failure to thrive, asthma, pneumonia, neuromuscular disorders and suspected foreign body inhalation have been ruled out in the pediatric patient.

Microforceps in the Diagnosis of Pancreatic Bronchogenic Cyst Under Endoscopic Ultrasound Guidance

ABSTRACTBronchogenic cysts belong in the category of foregut duplication cysts, along with esophageal and neuroenteric duplication cysts. They are often found incidentally on cross-sectional imaging. Although they are benign, patients often undergo surgical resection because of diagnostic uncertainties. We report the first case of bronchogenic cyst diagnosed with the microforceps, after previous nondiagnostic fine-needle aspirations, thus allowing the patient to avoid surgery.

Ileal duplication cyst: a rare cause of intestinal obstruction in infants

Ileal duplication cyst (IDC) is a rare congenital anomaly where there is an abnormal portion of intestine attached to or intrinsic with the normal bowel. A 6-month-old male child presented with obstipation and bilious vomiting at emergency. X-ray abdomen showed multiple air fluid level suggestive of intestinal obstruction. Laparotomy was performed. Diagnosis of IDC was made and resection with primary anastomosis was done. Post-operative period was uneventful, and patient did well during 3 month follow-up checkup. IDC is a rare cause of intestinal obstruction which can present with different clinical symptoms posing a diagnostic dilemma. Diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment where imaging method is unavailable for exact diagnosis.

Retroperitoneal isolated enteric duplication cyst

Abstract Enteric duplication cysts are rare congenital malformations of the gastrointestinal tract with an estimated incidence of 1:100,000 live births. Fewer still are isolated enteric duplication cysts (IEDC). Accurate diagnosis and timely excision of IEDCs can help in avoiding possible complications including bleeding from gastric mucosa and malignant transformation later in life. Currently, in the paediatric population, there are twenty reported cases in the literature worldwide. Of these, only three have been described in the retro peritoneum. We present a retroperitoneal IEDC, which was juxtaposed to the inferior vena cava. To the best of our knowledge, this has not been reported before in literature.

Gastric duplication cyst in an infant: A case report

Abstract Gastrointestinal duplication is an infrequent congenital disorder, presenting a mucosal-covered muscle layer. Gastric duplication cysts comprise about 2–9% of all gastrointestinal duplication cysts. The clinical picture is usually characterized by epigastric pain, vomiting and palpable abdominal mass, which may present in other more frequent diseases. Diagnostic confirmation often requires complementary imaging exams and treatment is always surgical. We report the case of a 2 month-old girl, presenting with incoercible, non-bilious vomiting after feeding with an initial diagnosis of hypertrophic pyloric stenosis. After a more thorough investigation, she was diagnosed with a gastric duplication cyst in the pylorus region. A laparotomy was performed with complete cystic resection. The followup visits were uneventful with complete resolution of symptoms. Gastric duplication have less than 50 reported cases. When it is located in the pylorus, it presents with earlier symptoms, including in the neonatal period, simulating cases of pyloric hypertrophic stenosis, as in the case reported here. Clinical examination and imaging help to determine the most accurate diagnosis, allowing appropriate surgical treatment, avoiding future complications including malignant tumors.

CHRONIC CONSTIPATION IN INFANTS: THINK ABOUT RECTAL DUPLICATION

Rectum is the least common site of gastrointestinal duplication. Up to now fewer than 100 cases have been reported in the literature. We present two infants with cystic rectal duplications manifested with chronic constipation as a main clinical symptom. The first patient was a 4-year-old boy who was admitted to emergency department because of chronic constipation unresponsive to fiber supplements and laxatives. Digital rectal exam revealed mass adjacent to posterior rectal wall. Abdominal ultrasound and magnetic resonance imaging confirmed oval, homogenous and hypoechogenic cystic mass (87x65x60 mm in size) behind the rectum. The size and location of the cystic mass was confirmed by magnetic resonance imaging. The second patient was an 11-month-old boy who was hospitalized due to rectal bleeding. He was suffering from chronic constipation over the last five months. Digital rectal exam revealed a mass behind the rectum. Abdominal ultrasound and computed tomography showed unilocular cyst (33X33 mm in size) in front of the urinary bladder, partly extending into retrorectal space. Both patients were operated on. Postoperative periods were uneventful in both of them. Cystic rectal duplication must be ruled out in all infants with chronic constipation unresponsive to conservative treatment. Different imaging techniques are currently used to determine the precise size and location of duplication. Surgery is the only possible therapy option.

Cecal duplication cyst complicated by prolapsed ileocolic intussusception

Abstract Cecal duplication cysts are very rare including 0.4% of all GI tract duplications. The ultrasound (US) is the imaging of choice for duplication cysts detection in pediatrics. Cyst's wall is made up of an inner mucosal layer, which is echogenic and an outer muscular layer, which is hypoechoic at US (called “pseudo kidney” appearance on longitudinal view or “doughnut” appearance on transverse view). Intussusception is one of the duplication cyst's complications. Intussusception presented with trans-anal protrusion (prolapsed intussusception) is a rare and confusing condition which can cause delayed diagnosis and further complications. We present an 18-month old boy with Cecal duplication cyst causing intussusception, which protruded from anus.

Gastric duplication cyst fistulized with the colon in an adult: A case report

AbstractGastric duplication cyst is uncommon congenital malformation rarely seen in the adult population. Although complications related to duplication such as infection, haemorrhage, obstruction, and fistula formation with neighbouring structures had been previously reported, fistulization into the colon in adult has been previously never described to our knowledge. In this study, we present the case of a 36‐year‐old male patient with moderate mental retardation who presented with 10 months history of progressive abdominal pain, nausea, vomiting, and important weight loss. Clinical assessment and radiological investigations demonstrated the presence of non‐communicating gastric duplication cyst inserted on the greater curvature of the antrum and fistulized into the transverse colon. At laparotomy, the cyst was completely excised and the colon containing the fistula was resected with colo‐colonic anastomosis. Pathology confirmed gastric duplication and demonstrated that the inner surface of the cyst was lined by gastric type mucosa. The patient had an uneventful recovery and after 3 months of follow‐up, all symptoms disappeared. Also, he gained 11 kg in weight. This case highlights, therefore, the fact that all gastric duplication cysts should be removed in order to avoid the risk of serious complications.

Duplication Cysts in Caecum in Three Months Old Girl

Gastrointestinal duplication cysts are rare congenital anomalies. It can occur in any part of the alimentary tract but they are rare in the caecum. The reported incidence is 1:4.500 births. The exact etiology is unknown. There is no common clinical pattern of signs and symptoms of duplications. The perioperative diagnosis duplication of cysts are often inaccurate. Histopathological examination enables us to confirm the diagnosis. Resection is the treatment of choice with an excellent outcome. The aim of this case report was to describe the clinical presentation and treatment of duplication cysts. A three months old girl had abdominal distention since 7 days before admitted to the hospital. This complaint was accompanied with fever and vomiting. She couldn’t have defecation and had history of black greenish feces. Physical examination revealed distended abdomen and decreased of bowel sound. Laboratory investigation showed normal features, abdominal X-Ray found enlargement of the intestine with increasing of the gas distribution and ground glass appearance. We diagnosed the patient with observation of abdominal distention caused by suspect ileus paralysis with different diagnosis hirschsprung disease. After the diagnosis, laparotomy exploration were performed. During surgical procedure, the surgeon found duplication cysts in the caecum area, then they performed resection with end to end anastomose and took the tissue for biopsy. The biopsy result was duplication cysts. Nine days after surgery, the patient was discharged in good condition. A high index of suspicion for diagnosis duplication cysts was required and the result of surgical treatment was good.