Duplication Cyst Research Articles

Clinical features of colorectal duplication in children: A study of 25 cases

PurposeTo describe the clinical features and surgical management of pediatric colorectal duplication. MethodsTwenty-five patients with colorectal duplication at Beijing Children's Hospital between January 2010 and December 2020 were reviewed. Colorectal duplications were divided into cystic, diverticular, tubular and mixed types according to shape. ResultsOf the patients, 64% were female, and 44% had accompanying malformations. Abnormal prenatal ultrasound findings (24%), abnormalities immediately found after birth (28%), and postnatal subjective symptoms (48%) were the main clinical presentations. Cystic lesions were observed in 16 patients (64%), including 12 in the colon and 4 in the rectum. Diverticular lesions were observed in 4 patients (16%), and all originated from the sigmoid colon. Among the 4 patients (16%) with tubular lesions, 3 involved the total colon, and the other originated from the splenic flexure to the proximal sigmoid colon. The patient with mixed duplication presented an intact enteric cyst within tubular duplication of the total colon. The mean age at surgery was 20 (0.3–130) months. Except for 4 total colon duplications, complete surgical resection of duplication lesions was performed in all patients. The “distal cross-section, mucosa stripping, and closure” procedure was performed in 3 patients with total colon duplication. Eighteen patients (72%) were followed up for a median time of 54.5 (5–129) months and recovered uneventfully. ConclusionsOwing to various clinical presentations, colorectal duplication requires careful preoperative differential diagnosis. Complete surgical resection is the preferred radical method for treating cystic, diverticular and short tubular colorectal duplications, except for total colon duplications. Level of EvidenceLevel IV.

VP11.18: Foregut and midgut duplication cysts with ileal atresia

Foregut and midgut duplication cysts associated with ileal atresia are not common gastrointestinal tract malformation. Thoracal and abdominal cystic masses was found in a young mother primigravida at 27 weeks of pregnancy on ultrasound. There was huge cystic mass measuring 44.0 x 42.0 mm unilaterally in the right inferoposterior hemithorax and cystic mass in central-left abdomen with segmental small bowel distention. Our preliminary diagnosis was CCAM type I or foregut duplication cyst. Delivery occurred by Caesarean section at 39 weeks with delivering a baby boy weighing 3700g. He had episodic bloody stool and dispnoe. Performed thoracal MRI and huge cystic mass measuring 55.0 x 52.0 mm was found in the right posteroinferior hemithorax, diagnosing CCAM Type 1 or foregut malformation. Neonate was taken up for thoracotomy on first month of life and huge cystic mass was resected and histopatological findings confirmed foregut duplication cyst. The baby was discharge home. A period of bloody stool was repeated and later he was entered to clinic with profuse intestinal bleeding. The exploratory laparotomy was done, distal ileal atresia with perforated terminal ileal duplication cyst was confirmed at surgery. Mentioned above segment of small bowel was resected and sometime later he was discharged home with recovery. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Gastrointestinal Bleeds.

Gastrointestinal Bleeds.

INFECTED SIMULTANEOUS MEDIASTINAL BRONCHOGENIC CYST AND ESOPHAGEAL DUPLICATION CYST MASQUERADING AS A LUNG ABSCESS

TOPIC: Genetic and Developmental Disorders TYPE: Fellow Case Reports INTRODUCTION: Bronchogenic and esophageal duplication cysts are rare but significant developmental anomalies. We present a case with both types of cyst in a single mass mimicking a lung abscess with a protracted treatment course. CASE PRESENTATION: A healthy 26-year-old female was admitted with onset of left sided pleuritic chest pain and fever over 24 hours. Her exam was remarkable for fever and tachycardia; she had elevated markers of infection. Computed tomography (CT) of chest revealed a well-demarcated cystic mass in the left hemithorax with an air-fluid level. She had no prior chest imaging and denied aspiration events or substance use. She was thought to have an intraparenchymal lung abscess, and underwent CT guided aspiration with the drainage of frank purulent material. Because of suspected intraparenchymal location no drain was placed. Fluid cultures and cytology were negative but her sputum grew mucoid pseudomonas aeruginosa, which was an atypical pathogen in this patient. She was treated with four weeks of intravenous cefepime, and two weeks of levofloxacin and metronidazole, with serial imaging. Pleuritic chest pain persisted despite regression of the lesion over a 10-month period (Figures 1-3); after which she underwent resection through a left video-assisted thoracic surgical approach. Intraoperatively, a large densely adherent inflammatory lesion was connected to the esophagus without intraluminal connection. Thick purulent fluid from the cyst was sent for culture and cytology, which were again negative. Pathology of the cystic mass was consistent with an esophageal duplication cyst (EC) (Figure 4B) with an additional noncommunicating bronchogenic cyst (BC) (Figure 4A). At 6months follow-up visit, she was doing well and free of symptoms. DISCUSSION: To our knowledge this is the first case report of de-novo infected dual BC/EC in an adult. Our case highlights the need for consideration of congenital cysts while working up lung abscesses. The diagnosis may be difficult without surgical resection, as characteristic imaging findings are missing in up to half of cases. 1There is likely a role for aspiration of the cyst for both diagnostic and therapeutic purposes, however efficacy and safety data are limited.2 The optimal timing of cyst resection is also not clear, especially in asymptomatic cysts. There is a minimal evidence to support universal surgical resection, though infected and symptomatic cysts will continue to need surgical intervention. 2,3 CONCLUSIONS: Infected congenital cysts can present a diagnostic and therapeutic challenge. Atypical presentations, and lack of improvement with appropriate therapy, are important clues to the diagnosis. REFERENCE #1: St-Georges R, Deslauriers J, Duranceau A, Vaillancourt R, Deschamps C, Beauchamp G, Pagé A, Brisson J. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg 1991; 52:6–13. REFERENCE #2: Kirmani B, Kirmani B, Sogliani F. Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery? Interact Cardiovasc Thorac Surg. 2010 Nov; 11(5): 649-59. REFERENCE #3: Fievet L, Gossot D, de Lesquen H, Calabre C, Merrot T, Thomas P, Becmeur F, Grigoroiu M. Resection of bronchogenic cysts in symptomatic versus asymptomatic patients: an outcome analysis, The Annals of Thoracic Surgery (2020) DISCLOSURES: no disclosure on file for Gary Hochhheiser; No relevant relationships by Obieze Nwanna Nzewunwa, source=Web Response No relevant relationships by Edmund Sears, source=Web Response No relevant relationships by Hilamber Subba, source=Web Response

S3626 First Reported Case Utilizing EUS-Guided Biopsy to Assist With the Diagnosis of the Duodenal Duplication Cyst

S3626 First Reported Case Utilizing EUS-Guided Biopsy to Assist With the Diagnosis of the Duodenal Duplication Cyst

THORACOSCOPIC EXCISION OF SYMPTOMATIC ESOPHAGEAL DUPLICATION CYST IN ADULT POPULATION-EXPERIENCE FROM A TERTIARY CARE CENTER

Gastrointestinal duplications are rare congenital anomalies in children. The most common site being jejunum and ileum, followed by mediastinum, colon, stomach, duodenum and rectum. Esophageal duplication cysts accounts for twenty percent. Majority of them are detected in childhood and treated. A very small percentage can present in adult population posing diagnostic challenges due to the clinical presentations. Minimal access surgery has obviated the need for thoracotomy. Herein we share our experience of treating four symptomatic esophageal duplication cysts in adults, by minimally invasive approach.

Intraluminal pyloric duplication cyst- a rare cause of non-bilious vomiting in a neonate: A case report

Background: Duplications of the alimentary tract are rare congenital malformations, out of which, true pyloric duplications constitute only 2.2%. They present with non-bilious vomiting and mimic hypertrophic pyloric stenosis (HPS). Pyloric duplications that are intraluminal are not separately visible at laparotomy, making their diagnosis difficult. Case presentation: Our case is a neonate with an intraluminal pyloric duplication cyst who presented with recurrent vomiting. The radiological evaluation suggested a duplication cyst medial to the second part of the duodenum towards the stomach’s lesser curvature with features of gastric outlet obstruction. Intraoperatively, a cystic mass of 1 x 2 cm intraluminally was found on opening the pylorus which was excised and pyloroplasty was done. Postoperatively the baby was discharged in a stable condition. Conclusion: Intraluminal pyloric duplication cysts are rare and the clinical presentation mimics HPS. They should be considered as a differential diagnosis in a neonate presenting with features of gastric outlet obstruction.

Role of 99mTc sulphur colloid lymphoscintigraphy in a rare case of chylothorax and lymphocele formation post esophageal duplication cyst excision

We report a rare case of chylothorax with lymphocele formation post esophageal duplication cyst (EDC) excision in a 2 year old male child. Patient developed chylothorax after excision of EDC. Pleural fluid cytology showed increased triglycerides and cholesterol levels. Filtered Tc-99m Sulphur colloid lymphoscintigraphy showed abnormal radiotracer uptake in the lower thoracic region on right side corresponding to lymphocele on SPECT-CT images with possible site of leak medially. In addition, Tc-99m pertechnetate scan was done to rule out possibility of residual duplication cyst revealed no abnormality. Patient underwent open and en-masse ligation of the duct. Patient recovered completely post-surgery. This case highlights the importance of lymphoscintigraphy with SPECT-CT in the evaluation of patients with post-operative complications of chylothorax with detection of site of chyle leak.

Prenatal diagnosis of gastric duplication cyst at the fundus

A male infant was born via normal spontaneous delivery at 39+4 weeks of gestation with a birth weight of 3135 g by a G2P0A0 mother. A spherical anechoic lesion (1.5 cm) abutting the gastric fundus was found on prenatal ultrasonography at 29+4 weeks of gestation. This cystic mass exhibited an indistinct “double-wall” sign with a hyperechoic inner layer and hypoechoic outer layer (Fig. 1A). For further differentiation of duplication, splenic, or suprarenal cysts, magnetic resonance imaging (MRI) was performed using a 1.5 T scanner at 30+5 weeks of gestation.

Ovarian cysts

Ovarian cysts

Double gall bladder centred on inflamed gall bladder like vestigial primordium/intestinal duplication cyst with significant complications

Double gall bladder centred on inflamed gall bladder like vestigial primordium/intestinal duplication cyst with significant complications

Pancreatic ductal adenocarcinoma in a patient with pancreas divisum and gastrointestinal duplication cyst: a case report

BackgroundThe complication of duplication of alimentary tracts and pancreas divisum (PD) is a rare malformation and the development of pancreatic ductal adenocarcinoma (PDAC) in this malformation is also extremely rare. There have been some reports of complication of malignancy in a gastric duplication cyst (GDC) and PD. However, there have been no reports of complication of PDAC in cases with GDC and PD.Case presentationA 54-year-old woman was followed up at the previous hospital due to a history of ovarian endometrial adenocarcinoma. She also had a surgical history of partial excision for a GDC and pancreatic tail of PD in her childhood. A gynecological follow-up computed tomography (CT) examination revealed the pancreatic body tumor and the bifurcated main pancreatic duct dilatation. Furthermore, magnetic resonance cholangiopancreatography also revealed that the ventral main pancreatic duct communicated with the GDC. The initial levels of tumor markers were high, but we could not achieve preoperative histopathological diagnosis. The preoperative diagnosis was PDAC occurring in a case with PD and GDC. She received two courses of neoadjuvant chemotherapy with gemcitabine and nab-paclitaxel. A CT examination after neoadjuvant chemotherapy revealed the shrinkage of the tumor, and then we performed distal pancreatectomy with splenectomy and GDC resection. A histopathological examination revealed invasive PDAC and lymph node metastases; pathological staging was T1N1M0, stage III. Furthermore, PD and GDC were also histopathologically detected. The postoperative course was uneventful, and she was discharged on the postoperative day 25. She received S-1 monotherapy for 6 months, and no recurrence has been detected at 1 year after radical resection.ConclusionsWe herein presented an extremely rare combined case of PD, GDC and PDAC. We successfully treated it by neoadjuvant chemotherapy and distal pancreatectomy with GDC resection, and postoperative chemotherapy.

Gastrointestinal duplication cysts: what a radiologist needs to know.

Gastrointestinal tract duplication cysts are rare congenital malformations which can be diagnosed as early as the prenatal period but are frequently found in infancy or incidentally in adulthood. They can be seen throughout the alimentary tract with the most common involving the distal ileum and second most common the esophagus. Many duplication cysts are asymptomatic and thus discovered as an incidental imaging finding, though they can also be symptomatic with an array of clinical presentations dependent largely on their location. The vast majority of duplication cysts are benign; however, there are rare instances of malignant transformation reported. The aim of this review is to show how multimodality imaging can help in the diagnosis of duplication cysts at various anatomical locations. Duplication cyst can become symptomatic and in rare cases undergo malignant transformation; therefore, they are typically managed with surgical excision, particularly if found prenatally or during infancy. Given the diversity of anatomic locations, multiple differential diagnoses, and the need for surgical intervention, it is valuable to comprehend the role of multimodality imaging role in diagnosing duplication cysts.

Clinical features of gastric duplications: evidence from primary case reports and published data

BackgroundAlimentary tract duplications are rare congenital lesions, and only 2–8% of them are located in the stomach. Gastric duplications (GD) can lead to severe adverse events. Thus, surgical resection is required once the disease is diagnosed. The main purpose of this study is to describe the clinical features of gastric duplications and to provide evidence for the diagnosis and treatment.MethodsA retrospective review of eight gastric duplications at two medical centers Peking University People’s Hospital (PKUPH) and Shandong Provincial Hospital from 2010 to 2020 was conducted. Furthermore, the literature search was also conducted by retrieving data from PubMed, EMBASE and Cochrane Library databases from the date of the database inception to January 15, 2021.ResultsEight patients who were diagnosed as gastric duplications and 311 published records were included in this study. In all, 319 patients were identified: Vomiting and abdominal pain were the most frequent clinical presentations among juveniles and adults respectively. There was no difference in gender distribution (F: 53.16% vs M: 46.84%), and the cystic gastric duplications were the most common type of the gastric duplications (87.04%). More than half (53.30%) of included cases were located in the greater curvature of stomach.ConclusionsGastric duplications could present with a wide spectrum of symptomatology, which might be misdiagnosed easily as other diseases. For cystic gastric duplications, the optimal treatment was a complete surgical removal. But conservative treatment might be an alternative strategy for tubular gastric duplications.

A cystic jejunal duplication under the liver confused with a choledochal cyst.

A cystic jejunal duplication under the liver confused with a choledochal cyst.

Magnetic Resonance Imaging in Giant Perianal Epidermoid

AbstractPerianal epidermoid cyst is a rare entity and is commonly diagnosed late owing to its slow-growing nature. Imaging plays a vital role in diagnosis and differentiation from other cysts such as dermoid, tailgut, and rectal duplication cysts. Magnetic resonance imaging (MRI) is the preferred modality as uncomplicated cases show typical signal changes. Diffusion-weighted imaging has a definite additional role. We report a case of a giant perianal epidermoid diagnosed on MRI and successfully managed surgically.

Small cell neuroendocrine carcinoma arising in cystic duplication of colon.

Small cell neuroendocrine carcinoma arising in cystic duplication of colon.

Risk factor analysis and outcomes of airway management in antenatally diagnosed cervical masses

PurposeTo investigate antenatally-determined imaging characteristics associated with invasive airway management at birth in patients with cervical masses, as well as to describe postnatal management and outcomes. Study designA retrospective analysis of 52 patients with antenatally diagnosed neck masses was performed using single-center data from January 2008 to January 2019. Antenatal imaging, method of delivery, management, and outcomes data were abstracted from the medical record and analyzed. ResultsAntenatal diagnosis of neck masses in this cohort consisted of 41 lymphatic malformations (78.8%), 6 teratomas (11.5%), 3 hemangiomas (5.8%), 1 hemangioendothelioma (1.9%), and 1 giant foregut duplication cyst (1.9%). Mean gestational age at time of diagnostic imaging was 29 weeks 3 days (range: 19w4d – 37w). Overall, 22 patients (42.3%) required invasive airway management at birth, specifically 18 patients (34.6%) required endotracheal intubation and 4 (7.7%) required tracheostomy. 15 patients (28.8%) underwent ex-utero intrapartum treatment (EXIT) for the purposes of securing an airway. Polyhydramnios, tracheal deviation and compression, and anterior mass location on antenatal imaging were significantly associated with incidence of invasive airway intervention at birth, EXIT procedure, and tracheostomy during the neonatal hospitalization (p < 0.025; Fisher's exact test). Logistic regression analysis demonstrated statistically significant association between increasing antenatally-estimated mass volume and incidence of invasive airway management at birth (p = 0.02). Post-natal cervical mass management involved surgical excision (32.7%), sclerotherapy (50%), and adjuvant therapy with rapamycin (17.3%). Demise in the neonatal period occurred in 4 (7.7%) patients. ConclusionThis series documents the largest single-center experience of airway management in antenatally diagnosed cervical masses. Fetal imaging characteristics may help inform the appropriate method of delivery, airway management strategy at birth, and prenatal counseling.

Cecal Duplication

Background: Enteric duplication cysts are rare congenital malformations that are most commonly found in the ileum and ileocecal junction, followed by the esophagus, stomach, and duodenum. Although most present in the 1st 2 years, they are often difficult to diagnose as both presentation and radiological findings can be variable and nonspecific. Clinical Description: We present the case report of an 11-month-old child who presented with nonbilious vomiting and diarrhea. There was no fever, abdominal distension, blood in stools, or crying on defecation. A provisional diagnosis of acute gastroenteritis was kept and management started as per the standard protocol. Management: A series of investigations were carried out when the child did not improve and developed bilious vomiting. Ultrasound findings were suggestive of an ileal duplication cyst which was confirmed by magnetic resonance imaging. The child then underwent surgery where cecal duplication cyst was confirmed, which was previously missed due to a malpositioned cecum. Conclusion: Gastrointestinal duplication cysts are rare developmental anomalies that may present as an acute abdomen in a young child. The possibility of the duplication cyst should be kept as a differential diagnosis in a child presenting with unexplained vomiting, abdominal distension, or pain. Early suspicion, investigation, and intervention help in faster recovery with minimal complications.

The following surgery was performed using the Uniportal VATS technique. During the exploration of the pleural cavity, we have found numerous adhesions that were cut. We confirmed the presence of the cystic lesion in the posterior mediastinum, which was developed from the esophageal wall, with the greater extension from the diaphragm to the neck as shown by the chest CT

The following surgery was performed using the Uniportal VATS technique. During the exploration of the pleural cavity, we have found numerous adhesions that were cut. We confirmed the presence of the cystic lesion in the posterior mediastinum, which was developed from the esophageal wall, with the greater extension from the diaphragm to the neck as shown by the chest CT