Enteric Duplication Research Articles

Endoscopic Treatment of Colonic Duplication Cyst

Introduction: Colonic duplication cyst is a rare congenital abnormality commonly presenting before age of 2 years. We here present a case of endoscopic ultrasound (EUS) guided diagnosis and treatment of colonic duplication cyst. Case report: A 42-year-old African-American female underwent colonoscopy for evaluation of constipation. She denied any associated history of anorexia, weight loss or hematochezia. Her colonoscopy showed a large submucosal lesion at the hepatic flexure. The lesion was tattooed by India ink and the patient was referred to advance endoscopist for further evaluation. Meanwhile her CT scan of abdomen with contrast was done which was showed a small cystic lesion around splenic flexure. On repeat Colonoscopy with endoscopic ultrasound (EUS), a tattooed subepithelial lesion was seen in the hepatic flexure (Figure 1). On EUS, a 14 mm anechoic lesion lined by mucosa consistent with duplication cyst was seen (Figure 2). The mucosa was then snared exposing the cyst (Figure 3). The patient was discharged home with outpatient follow-up. Pathologic evaluation showed normal colonic mucosa without any dysplastic changes.Figure: Intraluminal mass at hepatic flexure (A) and transparent appearance (B).Figure. 12: MHz EUS images showing subepithelial anechoic lesion lined by mucosa.Figure: Fluid drainage after unroofing the cyst cavity (A) and flattening of lesion after drainage (B).Discussion: Enteric duplication cysts are rare entity encountered in pediatric age group and extremely rare in adults. Most common site of enteric duplication cyst is Ileum followed by ileocecal valve with colonic duplication cyst comprising only 6.8% in one case series. These cysts commonly occur on the mesenteric side of bowel and share a common blood supply with native bowel. The clinical presentation varies in patients ranging from abdominal pain, volvulus, intussusception, ischemic bowel, obstruction, and constipation. CT scan and US abdomen are helpful in making the diagnosis of duplication cyst. US may reveal fluid filled complex cyst with internal echoes. They are also characterized by typical inner echogenic mucosa and outer hypoechoic muscle layer. Cases of malignant transformation have rarely been reported in literature including one case of the metastatic disease. Surgical resection is classically being done for the cyst as they are found incidentally or intraoperatively. Effective drainage was established by hot snare resulting in resolution of patient's symptoms. Duodenal duplication cysts have been effectively drained and treated endoscopically commonly using needle knife papillotomy with good reported long-term outcomes. This case is the first reported case of EUS guided drainage of colonic duplication cyst.

Laparoscopic Treatment of Gastric Duplication in a Child

Abstract Introduction: Gastric duplication is a rare congenital anomaly with an incidence of 4%–8% of all gastrointestinal duplications; enteric duplications are ectopic cystic or tubular structure...

Non-communicating small intestinal duplication in a dog: a case report

Enteric duplication is rare in dogs. Here, we report the rarest form of duplication in which two segments are parallel and share a wall for most of their lengths. A nine-year-old spayed female Yorkshire terrier was referred to the Veterinary Medical Teaching Hospital at Gyeongsang National University due to anorexia and diarrhoea. Physical examination, haematological examination, radiography, and ultrasonography were performed. On physical examination, dry, pale mucous membrane was identified. Moderate anaemia with decreased packed cell volume was detected in complete blood count. Serum urea nitrogen and creatinine levels were mildly increased. Radiographic images revealed no significant findings. On ultrasonographic examination, a multi-layered appearance of a focal small intestinal segment was identified in the left mid abdomen. Following the lesion, it was divided into two small intestinal segments. Based on imaging findings, intussusceptions or enteric duplication were suspected. To resect the abnormal small intestinal segment, enterectomy was performed. Follow-up was not performed because the patient expired during the postoperative recovery time. The histopathological diagnosis was non-communicating small intestinal duplication. Non-communicating intestinal duplication is related to embryologic abnormalities and is usually concurrent with other anomalies such as vertebral malformations and urogenital duplications. However, this case had no other anomalies associated with the malformation of the intestine.

A case of an abdominal wall cystic urachal carcinoma in an unusual location

A solitary cystic lesion in the abdominal wall is generally benign, such as an omental cyst, mesenteric cyst, enteric duplication cyst, cystic mesothelioma, or skin appendage tumor. Furthermore, most malignancies in the urachal remnant are intraperitoneal lesions, and generally develop on the anterior aspect of the bladder dome. Moreover, most urachal glandular malignant neoplasms are the mucinous cystic type. We report a cystic urachal adenocarcinoma that presented as an abdominal wall cystic lesion. A 42-year-old woman was admitted to Kangwon National University Hospital for a 5-cm palpable abdominal wall mass. Conservative surgical excision was performed with subsequent histological and immunohistochemical evaluations, but only a few non-mucinous invasive glands and finger-like growths were noted. During a 2-year period, the tumor recurred several times along the urachal tract and metastasized to the regional lymph nodes. Despite receiving chemotherapy, the patient died 2 years after the first surgery.

An Unusual Cause of Recurrent Vomiting

Question: A 28-year-old man was admitted for postprandial epigastric pain, and chronic vomiting for 6 months, associated with a 6-kg weight loss. He had no relevant medical or family history. Physical examination and laboratory workup were normal. An anechoic lesion located in the second part of the duodenum wall was revealed on abdominal ultrasound imaging, and a submucosal mass was diagnosed in the same region, using an upper endoscopy technique (Figure A). Furthermore, endoscopic ultrasound imaging (Figure B) and magnetic resonance imaging with dynamic sequences (Figure C) showed a 25 × 26-mm cystic duodenal lesion. There was no connection between the lesion and the biliary and pancreatic ducts, which seemed to be normal. What is your diagnosis? How should the patient be treated? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Endoscopic ultrasound imaging showed an anechoic duodenal lesion with an inner echogenic ring and an outer hypoechoic ring. Abdominal magnetic resonance imaging found a consistent appearance of a duodenal cyst protruding into the duodenal lumen, in the second part of the duodenum. These findings are specific to an enteric duplication cyst. We performed an endoscopic treatment of the cyst. The cyst's roof was first punctured using a needle-knife papillotome. The wall of the cyst was then incised using a polypectomy snare. Pathologic examination showed a double muscle layer with both mucosal and submucosal layers (Figure D), confirming the diagnosis of duodenal duplication cyst. The patient was discharged of hospital 24 hours later. Follow-up was uneventful. Duodenal duplication cyst is a rare congenital malformation.1Chen J.-J. Lee H.-C. Yeung C.-Y. et al.Meta-analysis: the clinical features of the duodenal duplication cyst.J Pediatr Surg. 2010; 45: 1598-1606Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 2Antaki F. Tringali A. Deprez P. et al.A case series of symptomatic intraluminal duodenal duplication cysts: presentation, endoscopic therapy, and long-term outcome (with video).Gastrointest Endosc. 2008; 67: 163-168Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar Although exceptional malignant tumor developments have been described, duodenal duplication is usually associated with a good prognosis. Before the era of therapeutic endoscopy, surgical resection was performed in symptomatic patients, with significant morbidity. Various straightforward, safe, and effective endoscopic techniques have since been described, including cyst puncture, snare resection, and cyst needle aspiration/ligation, as suggested by Gjeorgjievski et al.3Gjeorgjievski M. Manickam P. Ghaith G. et al.Safety and efficacy of endoscopic therapy for nonmalignant duodenal duplication cysts.Medicine (Baltimore). 2016; 95: e3799Crossref PubMed Scopus (12) Google Scholar Long-term clinical outcomes are excellent, making therapeutic endoscopy a valid, minimally invasive alternative to surgical resection.

Thoraco-Abdominal Duplication Cyst- Role Tc-99m Pertechnetate SPECT-CT Scintigraphy in Localising Ectopic Gastric Mucosa.

Thoraco-abdominal duplication cyst, a congenital malformation of the posterior primitive foregut rarely presents with anaemia. Ectopic gastric mucosa is seen in around 20%-30% of the enteric duplication cysts. We report the scintigraphic findings of one such case which helped in final diagnosis and management of the patient.

Gastric Duplication Cyst-A Case Report

Commonest site for enteric duplications is small bowel and it is extremely uncommon for gastroduodenal region to get affected. Presentation maybe antenatal on anomaly scan or post natally when symptomatic due to complications. We report a 5month old girl who was brought with malena, abdominal pain and vomiting of two days duration with antenatal Ultrasound showing a cystic mass of unknown origin. On exploration, mass in the gastroduodenal region was found. Wide local excision with a part of the gastric wall &tail of pancreas was done. Histopathology was suggestive of gastric duplication cyst.

Enteric Duplication Cysts in Children: A Single‐Institution Series with Forty Patients in Twenty‐Six Years

The purpose of the study was to evaluate our experience with enteric duplication cysts in 40 children during the past 26years, while assessing the variability of their presentations and to propose an algorithm for surgical management. We retrospectively analysed sex, age, clinical presentations, duplication site, surgical treatment, presence of ectopic tissue, complications, associated anomalies, and prognosis of 40 patients with gastrointestinal tract duplications who were surgically treated in our clinic. Overall, there was a predominance of boys (28 males, 70%; 12 females, 30%). The presenting symptom was vomiting in 23 patients, rectal bleeding in 11 patients, abdominal mass in 10 patients, abdominal pain in 9 patients, constipation in 6 patients, cough in 2 patients, and respiratory distress in 2 patients. In 30 patients, a complete excision of the cyst with additional segmental intestinal resection and anastomosis was performed. Cystectomy was performed in seven patients, while complete excision of the cyst with additional wedge resection was performed in two. A Wrenn procedure (mucosectomy) was performed in one patient. Due to the variability in the site of enteric duplications, a wide range of presenting symptoms can exist, which is challenging for diagnosis. In children with a diagnosis of acute abdomen, enteric duplication cysts should be considered, and these children should be further investigated for additional skeletal, urogenital, and gastrointestinal system pathologies. Surgical treatment depends on the site and type of the cyst.

Hypergastrinemia and a duodenal ulcer caused by gastric duplication

BackgroundHypergastrinemia and the resultant peptic ulcer related to an enteric duplication has been quite rarely reported in the literature.Case presentationWe herein report the case of a 4-year-old girl who presented with hypergastrinemia and a duodenal ulcer at 2 years of age. She had been followed up with a proton pump inhibitor, which resulted in resolution of the ulcer; however, unexplained hypergastrinemia had continued. A cystic lesion at the antrum was discovered at 4 years of age, which we suspected to be a gastric duplication. After we resected the lesion, the hypergastrinemia resolved without recurrence of the duodenal ulcer. The histology was compatible with a gastric duplication, and the lumen was lined with antral mucosa that strongly stained positive for gastrin. We presumed that the antral mucosa inside the duplication in our case had no hydrogen ion feedback inhibition of gastrin release from gastrin cells and increased release of gastrin from the mucosa inside the duplication led to the duodenal ulcer. Only two cases have been reported in the literature that had hypergastrinemia related to enteric duplication.ConclusionGastric duplication should be included in the differential diagnosis of sustained hypergastrinemia in children.

Role of endoscopic ultrasound in pediatric gastrointestinal diseases

AbstractEndoscopic ultrasound (EUS) is a well-established diagnostic and therapeutic modality for adults. It is extremely helpful for a broad range of diagnostic indications including upper gastrointestinal (GI) malignancies, submucosal lesions, pancreatic lesions (masses, cystic lesions), chronic pancreatitis, etiological workup of recurrent acute pancreatitis, common bile duct evaluation (calculi versus tumor), gallbladder lesions/microliths, and rectal malignancy; well-established therapeutic roles include fine-needle aspiration of lesions/lymph nodes, pancreatic fluid collection drainage, pancreatic duct drainage, biliary drainage, gallbladder drainage, pelvic abscess drainage, celiac plexus block, or neurolysis. Some recent studies have reported the use of EUS in the pediatric population. EUS is safe and easy to perform in the pediatric population also. However, there is paucity of data on use of EUS in pediatric population. In contrast with its regular therapeutic use in adults, EUS is not commonly performed in children for therapeutic reasons and most of the data are available on diagnostic use only. All of studies have shown that EUS is safe and a useful modality with a positive impact on management in majority of study population. EUS is very useful in pediatric population for the evaluation of upper GI tract submucosal lesions or rectal masses, pancreaticobiliary disorders, characterization of esophageal strictures, and for evaluation of enteric duplication cysts. The advent of miniprobe that can be passed through conventional endoscopes has increased the applicability of EUS in infants and children. Although there are limited data regarding use of EUS in pediatric population, it appears to be a very promising diagnostic and therapeutic tool.

Failed Intussusception Reduction in Children: Correlation Between Radiologic, Surgical, and Pathologic Findings.

The objective of this study was to identify causes of irreducible intussusception after contrast enema and to correlate imaging findings with surgical and histopathologic findings. Between 2005 and 2013, a total of 543 children underwent reduction of intussusception with the use of an enema technique (hereafter referred to as "enema reduction"). The medical records of 72 children (56 boys [mean age, 24.8 months; range, 3.8 months to 10.9 years] and 16 girls [mean age, 14.2 months; range, 1.5 months to 6.9 years) who underwent unsuccessful reduction and were treated surgically were retrospectively analyzed. The data collected included information on the cause of intussusception, the risk factors noted on ultrasound, operative management, outcome, and the length of the hospital stay. The imaging findings for these patients were compared with findings for statistically similar age-matched control subjects. Ultrasound detected 56 of 57 cases of intussusception, but it failed to detect the lead point in three cases and failed to detect ischemic necrosis in seven cases. Positive predictors of failed enema reduction were the presence of a distal mass and observation of the dissecting sign. Of the 72 patients who underwent surgical treatment of intussusception, 26 (36.1%) underwent laparoscopy, 38 (52.8%) underwent laparotomy, and eight (11.1%) underwent conversion from laparoscopy to laparotomy. Surgical reduction was performed in 61.1% of cases, small bowel resection in 19.4%, ileocecectomy in 12.5%, and self-reduction in 69%. Pathologic lead points (noted in 25% of cases) included lymphoid hyperplasia (n = 7), Meckel diverticulum (n = 3), Burkitt lymphoma (n = 3), enteric duplication cyst (n = 2), juvenile polyp (n = 2), and adenovirus appendicitis (n = 1). The length of the hospital stay was significantly longer after laparotomy. The distalmost location of the intussusception mass and presence of the dissecting sign on images obtained during contrast enema have a higher positive predictive value for failed reduction. Screening ultrasound decreases the number of unnecessary contrast enemas performed; however, classic pathologic lead points, such as Burkitt lymphoma and Meckel diverticulum, may be difficult to diagnose with the use of ultrasound. Laparotomy and laparoscopy are equally safe and efficacious in reducing intussusception, with the length of the hospital stay after laparoscopy significantly shorter than that noted after laparotomy. Most failed enema reductions are idiopathic, and pathologic lead points are noted in 25% of cases.

Ectopic Immature Renal Tissue Associated with Lipomeningomyelocele and Enteric Duplication Cyst: A Report of Two Cases

Ectopic immature renal tissue (EIRT) is a lesion rarely described in the literature. It shows the components of a nephrogenic rest including the blastema, epithelia, and stroma. We report two cases of EIRT in a 3-year-old female and an 8 months male child, associated with lipomeningomyelocele and an enteric duplication cyst, respectively, along with detailed immunohistochemical profile. Though there are a few cases of EIRT associated with teratoma, only two cases of EIRT associated with lipomeningomyelocele have been described in the English literature. Moreover, extensive literature search did not reveal any previous case report where EIRT had been documented in an enteric duplication cyst.

Colorectal Duplication Cyst, Presenting with Recurrent Acute Intestinal Obstruction

Enteric duplication is a rare congenital anomaly which is commonly encountered in pediatric age group, and is rarely seen in adult patients. Ileum is the most common site of involvement (60%) followed by duodenum, stomach, jejunum, colon and rectum. Here we report a case of a 20-year old female presenting with acute intestinal obstruction, in which an initial diagnosis of Hirschsprung’s disease (HD) was considered and laparotomy, multiple colonic biopsies, appendectomy with loop ileostomy was done. The diagnosis of HD was disproved by presence of ganglionic cells in the colonic wall. Diagnosis of a long duplication, along the entire length of colon, was made when a CECT was done with instillation of contrast through the distal limb of ileostomy. A subtotal colectomy with division of septum between the residual cyst and rectum with colorectal anastomosis was done after a month and closure of ileostomy after another 3 months. The patient recovered well and is asymptomatic in follow-up.

Intraluminal Meckel's Duplication Cyst Causing Bowel Obstruction in an Infant: A Role for Laparotomy.

This report describes a two-month-old girl who presented with signs and symptoms of a distal small bowel obstruction. She underwent an abdominal ultrasound that revealed a right lower quadrant cystic mass. A Technetium-99 scan revealed increased activity in the right lower quadrant consistent with a Meckel's diverticulum. Following a nondiagnostic laparoscopic evaluation, a laparotomy was performed to allow direct palpation of the small bowel and colon. Direct palpation of the ileum revealed a soft intraluminal mass at the ileocecal valve. The child underwent an ileocecectomy and anastomosis incorporating the intraluminal mass. Pathologic analysis revealed an intraluminal enteric duplication cyst containing ectopic gastric mucosa. This case represents the first report of such an entity in an infant. A discussion of the diagnostic and therapeutic aspects of the case and enteric duplication cysts is provided.

Laparoscopic removal of autoamputated adnexa in infants and neonates

Objective The aim of this study was to describe a new case of autoamputated adnexa in a neonate treated with laparoscopy and to present a review of the literature as regards laparoscopic management of the autoamputated adnexa in neonates and infants. Summary background data Laparoscopic surgery has become an accepted modality internationally in neonates and infants. We analyzed technical details of laparoscopic procedures adopted in the literature for this rare condition. Materials and methods A literature review was performed to identify additional cases of autoamputated adnexa treated laparoscopically. Cases were limited to the English language and to those affecting girls under 1 year of age. Results In addition to our presented case, 12 cases of autoamputated adnexa in patients less than 1 year of age treated laparoscopically were identified in the literature. Surgical intervention was planned for increasing size of cysts, for no signs of reduction, or for complex cysts, except in one case for suspicion of enteric duplication. The number of ports for the removal varies from one to three based on different authors. The operative port size ranged from 3 to 5 mm. Camera size was 5mm for all authors when reported but only five authors reported the size of the umbilical port. Conclusion Although laparoscopic removal of autoamputated adnexa can be successfully accomplished in newborns and infants, 50% of autoamputated adnexa are still treated with laparotomy. Our review revealed the necessity of at least two ports for the identification and removal of the adnexa using the laparoscopic-assisted technique, whereas three trocars in the presence of tenacious adhesions. Keywords : adnexal torsion, autoamputated adnexa, laparoscopy, technique

Enteric Duplication Cyst Masquerading as a Malignancy

Enteric Duplication Cyst Masquerading as a Malignancy

Laparoscopic and Laparoscopy-Assisted Resection of Enteric Duplication Cysts in Children.

Enteric duplication (ED) cysts are rare. The commonness of ultrasonographic investigation contributes to an earlier diagnosis of such a pathology before the onset of the first clinical symptoms. A planned mini-invasive surgical treatment during the infancy is proposed. This study presents the possibility and safety of elective laparoscopic or laparoscopy-assisted mini-invasive resection of ileal (IL) and ileocecal (IC) duplications, thus avoiding bowel resection. A retrospective review was conducted of medical records of 6 patients at the age from 3 to 22 months with the diagnosis of ED, treated in the Department of Pediatric Surgery, Jagiellonian University Medical College, Krakow, Poland, within the period from January 2012 to September 2014. Excision of cysts without bowel resection was performed in five children with IC and IL duplications. Laparoscopic excision was performed in two children with IC duplication; in the other three children (1 IC and 2 IL duplication), laparoscopy confirmed the diagnosis with consecutive cyst excision without bowel resection after external evacuation of the cyst. The external resection of the cecum and Bauhin's valve was necessary in 1 patient with large IC duplication and malrotation. The postoperative course was satisfactory in all the cases. The laparoscopic approach allows for confirming the diagnosis and accurately defining the exact site of duplication, as well as for effective and safe mini-invasive treatment. Laparoscopic or laparoscopy-assisted excision of ED without bowel resection is a safe option in a significant number of IL and IC duplications.

Enteric duplication in children: Experience from a tertiary center in South India.

Background:Enteric duplications (EDs) are rare aberrations of the embryonic gut. This study was undertaken to define the clinical characteristics and management challenges of this unusual entity in the Indian population.Materials and Methods:Hospital records of 35 children with 38 ED operated between 2003 and 2014 were analyzed and followed up.Results:The median age at presentation was 285 days (range 1-day to 16 years) with male preponderance (71%). Small bowel duplications were the most common (44%), and thoracoabdominal duplications were seen in 8% children compared to 2% in the literature. The median duration of symptoms was 18 days (interquartile range [IQR] 3-210 days). Associated anomalies were seen in 49% children with vertebral and spinal anomalies being the most common. Ultrasonogram (US) was done in 83% children and had a sensitivity of 55%. In the presence of a gastrointestinal bleed, Technetium99m pertechnetate scintigraphy scan had a positive predictive value of 80%. Thirty-five lesions were completely removed. Mucosectomy was done in two children, and one total colonic duplication was left in situ after providing adequate internal drainage. There was no postoperative mortality. The follow-up was possible in 66% children.Conclusions:EDs are uncommon and have varied, nonspecific symptoms. Thoracoabdominal duplications are more common in the Indian population. The US is a good screening tool but requires a high index of suspicion where complete excision is not possible; the provision of adequate internal drainage is an acceptable alternative. The long-term prognosis of children with ED depends on the extent of physiological disturbance due to associated anomalies.

Enteric duplication cyst located at the posterior tongue: a rare case report and review of the literature.

The lingual localization of an enteric duplication is extremely rare but may present with respiratory and feeding problems that require emergency intervention. A 7-month-old boy was brought to our clinic with feeding difficulties and tongue swelling. Physical examination showed a cystic lesion located near the left side of the tongue base that caused tongue protrusion to the contralateral side. During surgery, a 3-cm diameter opaque thick-walled cyst was found to be very closely adherent to the base of tongue, which was excised in its entirety. Following surgery, the patient fed during the early postoperative period and no complications were observed other than hypersalivation. On histological examination, a cystic lesion lined with intestinal mucosa and goblet cells was found. We present the rare case of a duplication cyst of the posterior tongue, with a literature review.

Multiple Bronchogenic and Gastroenteric Cysts Arising from the Stomach in a Patient with Abdominal Pain

Bronchogenic cysts arising from the stomach are uncommon. We discuss a young female patient with presumed enteric duplication cysts who was found to have three bronchogenic and gastroenteric cysts upon pathologic review. We discuss the pathophysiology of bronchogenic cysts and their malignant potential.