Duplication Cyst Research Articles

Gastroschisis associated with intestinal duplication cyst

Abstract Introduction Gastroschisis is much less frequently associated with anomalies than omphalocele. The most common associated anomaly is gastrointestinal abnormalities. Intestinal atresia is found in 10–15% of cases of gastroschisis. Intestinal duplication is a very rare association. Case report We present a unique case of gastroschisis with an associated intestinal (colonic) duplication cyst in a 4 -day -old 36 weeks pre-term, delivered to a primiparous 16 year old mother, presenting on account of anterior abdominal wall defect with protrusion of bowel through a defect on the right side of the umbilical cord. Examination showed a tubular mass protruding through a 3 cm defect on the right side of the umbilical cord, with a narrow appendix -like appendage at the summit. Laparotomy was done within 24 h of admission. Findings include a protruding tubular mass adherent to the serosa and muscularis layer of the mid transverse colon and the adjacent greater omentum. Mass was excised. Results He did well postoperatively but developed surgical site infection which was managed by daily wound dressing. He was discharged 2weeks post operative and was doing well at last follow up visit. Histopathology confirmed smooth muscle lining of the cyst wall, with interspersed goblet cells within the mucosa. Conclusion This report underscores the importance of thorough examination of content of gastroschisis for prompt diagnosis of rare anomalies like intestinal duplication.

Multiple Jejunoileal Atresia and Stenosis with Duplication Cyst in a Newborn

Jejunoileal atresia is a congenital anomaly that is characterized clinically by bilious vomiting and abdominal dis-tension. It has been associated with various other anomalies but its association with mesenteric cyst is rare. We are presenting a patient with antenatally diagnosed duplication cyst with multiple jejunoileal atresia and stenosis with possible etiology behind such an association.

Insulated-tip knife: an alternative method of marsupializing a symptomatic duodenal duplication cyst in a 3-year-old child.

Insulated-tip knife: an alternative method of marsupializing a symptomatic duodenal duplication cyst in a 3-year-old child.

Undetected Duplication Cyst of The Cecum Until Adulthood

Intestinal duplication is a rare congenital anomaly of the digestive tract. It is often diagnosed antenatally or in the first two years of life. It is observed anywhere in the digestive tract, often in ileum and jejunum. We present a rare case of colonic duplication cyst in adult age in this paper. Our case was diagnosed by ultrasonography performed due to the complaint of chronic abdominal pain and was followed up for 18 months. The patient underwent surgery due to strong suspicion of malignancy. During the operation, the cyst was accessed only after palpation and was resected together with the right colon. The definitive diagnosis could be made by pathological examination. Duplication cysts can cause significant morbidity and even mortality if left untreated. For this reason, it is important to recognize this rare congenital anomaly.

Enteric Duplication Cyst in an Adult Presented With a Granuloma

Enteric Duplication Cyst in an Adult Presented With a Granuloma

A Systematic Review of Prenatally Diagnosed Intra-abdominal Enteric Duplication Cysts.

With improvements in prenatal ultrasound, more abdominal enteric duplication cysts (EDCs) are diagnosed prenatally. The optimal time for operative intervention is unclear. We aimed to review the evidence supporting the indication and timing of surgery for prenatally diagnosed EDCs. A systematic review was performed using a defined search strategy identifying articles with inclusion criteria of prenatal diagnosis of histologically confirmed EDCs. Outcomes included (1) indications for resection (symptoms vs. prophylactic) and (2) time from birth to operative intervention. Of 1,590 articles screened, prenatal diagnosis of histologically confirmed EDCs was made in 68 articles, detailing indications and timing for resection for 86 patients. Thirty-five patients (41%) became symptomatic early and were resected promptly at a median of 2 days of age. Indications for intervention included bowel obstruction, volvulus, bleeding, recurrent pain and diagnostic dilemma (concern for cystic neuroblastoma). There were 51 patients (59%) who were resected prophylactically at a median of 90 days of age without interval symptoms. Symptomatic cysts had a larger mean cyst diameter. There was a difference in the anatomic distribution of asymptomatic or symptomatic EDCs-gastric duplications were more frequently asymptomatic while jejunal, proximal ileal and colonic duplications were more frequently symptomatic. The optimal approach to EDCs diagnosed prenatally is not supported by strong evidence in the literature. Our systematic review indicates that almost half of the infants diagnosed prenatally become symptomatic early and are resected. In asymptomatic patients, close observation and delayed prophylactic resection in infancy can be considered.

Stool filling of an intestinal duplication cyst at the ileocecal valve triggers colonic intussusception: a case report

BackgroundIntestinal duplication, a congenital malformation, is considered a rare condition, particularly in adults. Although it affects young children, a minority of patients remains asymptomatic until adulthood. Here, we describe a case of an intestinal duplication cyst that caused intussusception by a unique mechanism.Case presentationA 19-year-old man was admitted to our hospital for intermittent abdominal pain. Computed tomography revealed colonic intussusception induced by a nodular mass in the ileocecal region. Urgent ileocecal resection was performed because of the risk of colonic ischemia. The resected material comprised a stool-filled noncommunicating cyst that protruded into the enteric lumen at the ileocecal valve. Histological analyses revealed that the inner wall of the cyst was lined with colonic mucosa and that the muscle layer of the cyst was shared with that of the original enteric wall; furthermore, the cyst had a vestige of an opening site in the wall. We concluded that the cyst was an intestinal duplication that poured stool into its lumen through the tiny orifice, thereby triggering intussusception.ConclusionsThe present case suggests that stool-pouring can cause intussusception into the space of an intestinal duplication lesion.

PS01.079: OF BARRIERS AND BALLOONS- SURGICAL MANAGEMENT OF ESOPHAGEAL IATROGENIC INJURIES USING PRIMARY REPAIR WITH A ROTATION DIAPHRAGMATIC FLAP: A SERIES FROM OMAN

Abstract Background Background Iatrogenic injuries of the Esophagus remain a challenging turf to dwell upon. Although the timing of surgical intervention, when indicated, may be controlled and hence is more favourable than other types of uncontrolled traumas, however the patient's pre-morbid state as well as the Esophagus’ presenting condition at the time of injury may confound the desired outcome. The Royal Hospital of Muscat is the biggest tertiary centre in Oman. The Upper GI surgical unit was established in 2010. In this small series, we highlight the valuable role of rotational diaphragmatic flaps in perforations of the lower Esophagus. Methods A case series of 4 patients presenting with iatrogenic esophageal injuries, who underwent primary repair with a rotation flap between 2012 and 2016. Results All patients had iatrogenic lower esophageal tears. The first was from an over inflated balloon of a calibrating tube, misplaced in the esophagus during a standard Sleeve Gastrectomy for Obesity. The second was an intraoperative perforation during a Thoracic surgical procedure for a duplication cyst. The third was a complication of an endovascular stent for a dissecting thoracic aorta aneurysm. The fourth was due to covered stent placed to seal a small perforation following variceal injection in a patient with Child's B liver cirrhosis. The average tear length was 3cms. All were operated within 48hours, before full sepsis had set in. The extent of contamination was localised and its degree minimal to moderate. All underwent a primary repair with a diaphragmatic rotation flap used as a second cover layer. Postoperative fluoroscopy showed intact surgical repair with good flow of contrast. The first three patients were discharged after an average of 12 days. The fourth succumbed to his liver failure and expired after two months in hospital. Conclusion Primary repair of iatrogenic lower esophageal injuries, when done early, could be consolidated with reasonable success using a diaphragmatic rotation flap. The flap's length is fashioned as required on a well vascularised pedicle. In comparison to other supportive techniques this flap is more flexible and its tissue more enduring as a good repair harness. Disclosure All authors have declared no conflicts of interest.

PS01.105: PANCREATITIS IN THE ESOPHAGEAL ECTOPIC PANCREAS: A RARE CONDITION WITH DIFFERENT PRESENTATIONS! TREATMENTS AND REVIEW OF THE LITERATURE

Abstract Background Ectopic pancreas is an extremely rare genetic malformation in the esophagus. It is defined by pancreatic tissue outside the pancreas and usually presents as a subepithelial lesion in the esophagus. To date, there are fewer than 15 patients reported in the literature. Methods We present 2 cases of pancreatitis in the esophageal ectopic pancreas with different presentation, treatment and development, as well as a review of the literature. Results 1. A 48-year-old woman admitted to the ER with acute dysphagia and chest pain. There were elevation of amylasemia and lipasemia, as well as presence of a tumor in the Gastroesophageal junction with hypersignal at the CT scan, suggesting acute inflammation. An echoendoscopy with biopsy, diagnosed ectopic pancreas in the distal esophagus. The patient was then submitted to laparoscopic resection of subepithelial tumor of the cardia, recovered by a fundoplication. The specimen confirmed pancreatic tissue with acute inflammation. 2. A 33-year-old woman with a history of episodic chest pain confused with GERD, nausea and vomiting pain episodes accompanied by elevated serum amylase and lipase levels. She was submitted to an ERCP without alterations to investigate the clinical complains. After some crisis she was hospitalized with a septic condition, where a CT scan revealed a cystic lesion in the lower mediastinum in the esophageal wall. Endoscopy was performed, showing a drainage orifice with purulent secretion in the cardia. She was treated with antibiotics and fasting. She had two more crises and was referred to our specialized service. Thoracoscopic subtotal esophagectomy with cervical anastomosis was performed for treatment of a suspected esophageal duplication cyst with recurrent infections. The specimen showed the presence of organized pancreatic tissue characterizing ectopic pancreas complicated with chronic pancreatitis. Conclusion The ectopic esophageal pancreas can be present as a differential of these lesions. The second case, was first admitted at a secondary care unit and the diagnosis was delayed, probably leading to a worse development and necessity of a esophagectomy. In the literature, there is only one description of 1 case of recurrent pancreatitis. We have shown that complications can range from dysphagia to abscess, requiring more invasive treatment. Disclosure All authors have declared no conflicts of interest.

Erosive effects of a posterior mediastinal mass in a 18th to early 19th c. Spanish child mummy.

During the 2011 restoration works in the central nave of the church of the Assumption of Our Lady, known as "The Piquete", in the village of Quinto (about 50 kms southwest of Zaragoza, Spain), the remains of 70 individuals were uncovered. Of these there were 32 mummified bodies, four of which have been investigated with CT scans. Here we report on the findings in one such individual, namely a child of between 7 and 8 years of age, whose sex is debatable but may well be female. The main pathological finding is the presence of pressure erosion and distortion of the upper thoracic spine, the cause of which is discussed with the conclusion that this may well represent a neurenteric duplication cyst. The possible consequences of such a lesion are considered.

Cervical Oesophageal Duplication Cyst: A Case Report.

Very few cases of cervical oesophageal duplication cysts have been reported in literature. Proper diagnosis and precise excision are the key to favourable outcome in this potentially dangerous lesion. Keywords: Duplication cyst, cervicaloesophagus Cite this Article Vinit K. Thakur, Vijayendra Kumar, Z. Hasan, Ramdhani Yadav, Digamber Chaubey, Sandip Kumar Rahul Cervical Oesophageal Duplication Cyst: A Case Report. Research & Reviews: Journal of Surgery . 2018; 7(2): 15–17p.

Adenosquamous carcinoma arising in a duplication cyst of the gallbladder.

A 52-year-old woman, previously healthy was admitted to another hospital due to right upper quadrant abdominal pain, fever and leukocytosis. An ultrasound demonstrated acute cholecystitis and lesion 8 cm. in diameter near the gallbladder. An abdominal CT scan showed the lesion in close proximity to the gallbladder, with fat infiltration. A percutaneous drainage of the lesion under CT guidance yielded a substance which was bloody and purulent in content. The patient improved clinically under antibiotics and was discharged from hospital with a recommendation for elective exploratory laparoscopy.

Duodenal Duplication Cyst in Close Proximity of Ampulla of Vater: A Surgical Challenge

Prompt preoperative diagnosis of duodenal duplication cyst is uncommon owing to its extreme rarity. The ideal treatment of intestinal duplication cyst is complete surgical excision, though in few cases, due to the proximity to the bilio-pancreatic duct, the complete excision is not possible. We herein present an infant presenting with bilious vomiting starting few days after birth. Ultrasonography and CT scan provided the diagnosis of the duplication cyst in relation to duodenum. A successful surgical management by a subtotal excision was done. Although duodenal duplication is seldom seen, it should be considered in differential diagnoses of upper gastrointestinal tract (GIT) occlusion.

Gastric Duplication Cyst Associated with Esophageal Atresia and Anorectal Malformations: A Rare Association

Esophageal atresia (EA) and tracheoesophageal fistula (TEF) and anorectal malformations (ARM) in a newborn usually present with frothing of saliva and massive abdominal distension rendering it difficult to diagnose associated intrabdominal pathologies. We report a large gastric duplication (GD) cyst in a 2-day-old neonate with EA and TEF. GD cyst was detected in the early post-operative period as the abdominal distension persisted after repair of EA and TEF. The baby underwent excision of GD cyst with good outcome thereafter.

Lesion size determines diagnostic yield of EUS-FNA with onsite cytopathologic evaluation for upper gastrointestinal subepithelial lesions.

The aim of this study was to determine the diagnostic yield and factors influencing the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for upper gastrointestinal (GI) subepithelial lesions (SELs) with rapid onsite cytopathologic evaluation. This is a single-center, retrospective study. Among 22 patients who underwent EUS-FNA, a cytopathological diagnosis was reached in 16 (72.7%) patients. The EUS-FNA results were as follows: seven GISTs (31.8%), six leiomyomas (27.2%), four non-diagnostics (18%), two duplication cysts (9%), two spindle cell tumor (9%), and one ectopic pancreas (4.5%). The long-axis size was > 20 mm in 12 patients (average size: 31.3 ±9.3 mm) and < 20 mm (average size: 16.6 ±2.5 mm) in 10 patients. Diagnostic accuracy of EUS-FNA from lesions < 20 mm was 50% (5/10 lesions), and of lesions > 20 mm was 91.6% (11/12 lesions) (Fisher's exact test; p=0.028). Six patients underwent surgical resection. Surgical pathology results of five lesions (four GIST, one leiomyoma) were consistent with cytopathology results (83.3%). The diagnostic yield of EUS-FNA of the upper GI SELs with an onsite cytopathologic interpretation was 72.7%. Lesion size < 2 cm significantly reduces the diagnostic yield of EUS-FNA for the upper GI SELs.

Gastric duplication in infants

Clinicians pay close attention to the questions related to the diagnosis and treatment tactics of stomach defects with its obstruction in view of their stable frequency and lack of consensus on these diseases development mechanisms. The insufficient individual experience of every clinician leads to the difficulties in early diagnostic and the most adequate surgical intervention choice, and so, high rates of mortality. Purpose of the work. Improvement of the diagnostic and treatment tactic in infants with gastric duplication. Materials and methods. Clinical experience of two cases of the newborn children treatment with rare variants of digestive tract developmental defects is presented. In one child it was a case of stomach cystic duplication; and the other had a cystic duplication of stomach and duodenum. Results. There have been 5 cases of the stomach duplication treatment in the last 5 years in the Pediatric Surgery Clinic of Zaporizhzhia State Medical University. Two children were diagnosed with this pathology in neonatal period. Clinical analysis of these cases is described in the article. Both infants have undergone the early operative intervention. Type and extent of the operation depended on the peculiarities of localization, sizes, clinical signs of the defects and the general state of patients. The main stages and methods of medical-diagnostic process of such patients’ management are presented. Conclusions. The analysis shows that the efficacy of stomach obstruction rare forms diagnosis is achieved by usage of algorithms based on the staged modern diagnostic methods, taking into account their resolution and congenital anomaly type. In congenital stomach and duodenum duplication maximal informativness can be achieved using ultrasound and CT (or MRI) of the abdominal cavity. The most effective and non-invasive is ultrasound method by high-resolution devices. The discussed clinical cases are examples of early diagnosis of the stomach duplication and the right choice of active tactics for such children management that has made it possible to obtain a successful treatment outcome.

Ileal Duplication Cyst Presenting With Acute Abdomen at Adult Age: Report of a Rare Case and a Review of the Literature

Gastrointestinal duplication cysts are rare lesions that typically present with acute abdomen in childhood. They are rare in adults, with only a few adult cases having been reported thus far. Adults with these lesions are usually asymptomatic or manifest with subtle abdominal symptoms. They may, however, also present with obstruction, bleeding, perforation, or malignancy. Herein, we aimed to report a case of ileal duplication cyst at adult age that presenting with symptoms of acute abdomen and reviewed the reported cases of adult age duplication cysts.

Case 253: Thrombosed Umbilical Venous Varix in an Infant

History A 3-month-old previously healthy girl presented to an outside institution with a 4-day history of low-grade fever, irritability, and a tender "knot" in the upper abdomen. Ultrasonography (US) was performed at an outside hospital. US images were not available for review; however, they showed a mass in the left hepatic lobe, per the outside report, and the patient was referred to our institution for further evaluation. Her parents reported a normal full-term pregnancy, with regular prenatal care and normal prenatal US findings. The baby was born after an uncomplicated gestation. She was delivered at term via an uncomplicated cesarean section due to a maternal history of cesarean section. The perinatal course was uncomplicated, and there was no history of umbilical catheterization, per the parents. On arrival at our institution, the patient had a temperature of 38.2°C. All other vital signs were normal. Palpation revealed a tender and firm mass in the periumbilical region; otherwise, physical examination findings were normal. Results of laboratory work-up were normal, except for elevated white blood cell count (26 600/mm3 [26.6 × 109/L]; normal, 6000-17 500/mm3 [6-17.5 × 109/L]). The patient underwent US followed by intravenous contrast material-enhanced (10 mL ioversol, Optiray 320; Medtronic, Santa Rosa, Calif) computed tomography (CT) on the same day.

Gastric duplication cyst with elevated CEA level: a case report

Gastrointestinal tract duplications are congenital malformations rarely seen in adulthood. Gastric duplications (GD) represent 2–9% of it. Malignant transformation of GD is a rare complication described in the literature. We present the case of a 43-year-old man, who presented an abdominal mass and an elevated CEA level. A total gastrectomy was performed and the histological examination described a gastric duplication cysts (GDC) without malignant transformation. It is not the first case of elevation of CEA in GDC without evidence of malignancy described in the literature. Some authors think that GDC are premalignant lesions that envolve with the time to carcinomas. It is recommend that once the GDC is diagnosed to remove surgically the entire cyst even if the patient is asymptomatic.

Acute pancreatitis caused by a duodenal duplication cyst covering the ampulla of Vater

Abstract Duodenal duplication cyst is not a common congenital anomaly and the pathophysiology may become very complicated if the cyst is situated at the ampulla of Vater. Here we report a very rare female case of duodenal duplication cyst at the ampulla of Vater, which caused acute pancreatitis due to massive protein plaques in the pancreatic duct. She had a past history of double duodenal atresia and underwent surgery as a neonate. The correct diagnosis could not be determined before the second operation at four years of age and the exact pathophysiology finally became apparent during the operation with a contrast medium study and duodenotomy. We discuss the complicated clinical features and diagnostic and treatment procedures before and during the operation.