Jejunal Duplication Cyst Research Articles

Jejunal duplication cyst in a female neonate: a case report.

Duplications are the abnormal portion of the intestine, either externally attached to the intestine or intrinsically placed within the bowel lumen. Their prevalence is noted to be around one in 25000 deliveries. The rare gastrointestinal tract duplication may be located in any part of the gastrointestinal system from the oral cavity to the anus. The most common site of enteric duplication cyst (DC) is the terminal part of the ileum. Hence, duplications in jejunum are rare. Hereby, the authors report a case of jejunal DC in a female neonate which was managed successfully via surgery and adequate post-operative care without any complications. Duplications are more frequently single. They are usually located in the mesenteric border of the associated native bowel and may vary in shape and size. Most of them are cystic, followed by tubular and mixed type, with or without other congenital anomalies. More than 80% of the cases present before the age of 2 years as an acute abdomen or bowel obstruction, but many duplications remain silent unless complications occur, and therefore may not be diagnosed until adulthood. Complications of enteric DC include volvulus, bleeding, and, rarely, malignant degeneration. It is important for paediatric surgeons to include DC in the differential diagnosis if a neonate presents with features of intestinal obstruction.

Gastrointestinal Bleeding in a Child: Is It a Meckel Diverticulum?

A 2-year-9-month-old boy with multiple episodes of melena and hematochezia with unclear cause was admitted to our hospital. Laboratory tests showed iron deficiency anemia (hemoglobin of 5 g/dL) and positive fecal occult blood test. Single-operator double-balloon enteroscopy (DBE) through the anal route was performed and revealed multiple patchy mucosal eminence consisted of ectopic gastric pit and loss of villi observed by electronic stain in the distal jejunum, approximately 2 m from the ileocecal valve. The bowel cavity was deformed like a maze in the distal jejunum. There are several mucosal bridging structures and focal stricture, making it difficult to determine the direction of the lumen. Two irregular deep ulcers were found near the stricture (A [a–f] and Video 1). Emission computer tomography Tc99m pertechnetate scan showed multiple areas of radioisotope uptake in the middle and lower abdomen. At laparotomy, a 46-cm-long cyst was noted on the mesentery aspect that protruded alongside from the distal jejunum (B [a–c]). Resection of 58 cm of the jejunum was performed including the cyst. Pathology showed a duplication cyst located on the mesenteric aspect with ectopic gastric mucosa (C). The postoperative diagnosis was a duplication cyst of the jejunum. The patient was discharged 14 days after surgery and remained symptom-free thereafter. Intestinal duplication cysts are rare congenital malformations that can appear anywhere in the gastrointestinal tract. The preoperative diagnosis of a duplication cyst is difficult and can be easily misdiagnosed as Meckel diverticulum. Duplication cysts usually locate on the mesenteric aspect as in our case, in contrast to Meckel diverticulum that localizes on the antimesenteric aspect. In our case, the deformed intestine was found approximately 2 m from the ileocecal valve, which was not common in Meckel diverticulum. To the best of our knowledge, this is the first reported tubular type of jejunal duplication cyst case with an DBE video. DBE can be a useful tool for the diagnosis of intestinal duplication in young children. Watch the Video, Supplementary Digital Content 1, https://links.lww.com/AJG/C853. (Informed consent was obtained from the patient to publish these images.)

A Rare Congenital Anomaly: Jejunal Duplication Cyst

Gastrointestinal duplication cysts are a group of rare congenital anomalies with incidence of 1 in 4500 births. They are encountered mainly during first 2 years of life or antenatally. Here we report a case of non-communicating duplication cyst of jejunum in a 29 days old infant who presented with complaints of bilious vomiting. Most of the cases are associated with some other congenital anomaly. Completely isolated jejunal duplication cyst is rare. This case is presented to create an awareness of this rare entity which can occur as different presentations causing significant morbidity and even mortality if timely management is not provided.

Gastro-intestinal duplication cyst with associated malrotation and volvulus in a 5-week-old infant

Abstract Enteric duplication cysts occurring in association with intestinal malrotation are rare, with only a handful of case reports published. We describe a 5-week-old female patient who presented to our institution with a one-day history of bile-stained vomiting with an associated large palpable abdominal mass on clinical examination. Ultrasound evaluation suggested a large cystic lesion arising from the right kidney, however, Intra-operatively we found a jejunal duplication cyst with an associated malrotation and midgut volvulus.

Isolated Jejunal Duplication Cyst Associated with Intestinal Malrotation in a Newborn.

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Pseudo Double Bubble: Jejunal Duplication Mimicking Duodenal Atresia on Prenatal Ultrasound

Prenatal ultrasound showing a “double bubble” is considered to be pathognomonic of duodenal atresia. We recently encountered an infant with prenatal findings suggestive of duodenal atresia with a normal karyotype who actually had a jejunal duplication cyst on exploration. A finding of an antenatal “double bubble” should lead to a thorough evaluation of the gastrointestinal tract and appropriate prenatal/neonatal testing and management as many cystic lesions within the abdomen can present with this prenatal finding.

Partial intestinal obstruction secondary to multiple lipomas within jejunal duplication cyst: A case report

Lipoma within jejunal duplication presenting as abdominal bloating and partial intestinal obstruction is an exceptional clinical entity. We report a case of 68-year-old man complaining of abdominal bloating for 10 d due to multiple lipomas arising from jejunal duplication cysts. Only a few cases of a single lipoma within a Meckel's diverticulum giving rise to this clinical scenario have been reported in the English language literature. However, no case of multiple lipomas within jejunal duplication cysts has been reported. We present a case in which double-balloon endoscopy revealed a small intestinal structure changed into Meckel's diverticulum-like cavities containing several lipomas. This case highlights intestinal lipoma as an uncommon cause of adult intussusceptions, which should be included in the differential diagnosis of small intestinal obstruction and appropriate examinations should be chosen.

Jejunal duplication cyst

Jejunal duplication cyst

Occult enterorrhagia from jejunal duplication causing diagnostic dilemma in an infant

Occult enterorrhagia in infancy may become obscured and lead to diagnostic dilemma. Abnormal findings on investigative modalities, if not properly interpreted and clinically correlated, might complicate the matter leading to missed diagnosis and chronic anaemia. Occult enterorrhagia is an uncommon presentation of intestinal duplications. We describe the intriguing case of chronic anaemia in an infant, where concomitant endoscopic findings misled the diagnosis of jejunal duplication cyst as the cause of enterorrhagia.

Lethal outcome after percutaneous aspiration of a presumed ovarian cyst in a neonate

Most surgeons agree that complex neonatal ovarian cysts, regardless of size, warrant operative intervention. Management of simple cysts >4 cm is still controversial, although many favor intervention because of the increased risk of torsion. Whereas laparoscopic cyst resection is favored by some, others prefer less invasive percutaneous needle aspiration. We present a newborn infant who was admitted with sepsis and respiratory failure after home delivery. Ultrasound done on day 8 to check for umbilical venous line placement incidentally showed a simple cyst measuring 3.6 x 5.9 x 6.9 cm that was presumed to be of ovarian origin. Percutaneous needle aspiration was atraumatic and revealed serous fluid, with a high estradiol level. Four days later, surgery was indicated for clinical deterioration with suspected hemorrhage into the cyst. We found a midgut volvulus with extensive necrosis secondary to a jejunal duplication cyst. Ovaries were normal and there was no evidence of malrotation. Postoperatively, after discussion with the parents, support was withdrawn and the child died. We should not rely solely on ultrasonographic features and fluid characteristics to diagnose a large neonatal abdominal cyst, but rather confirm the diagnosis with laparoscopy.

Letters to the Editor

Letters to the Editor

Iron-deficiency anaemia caused by an enterolith-filled jejunal duplication cyst

Enterogenous duplication cysts are rare, but recognised, developmental anomalies. Duplications in the midgut are the commonest of these rare anomalies with a high proportion of them being found in the jejunum. Enterolith formation within these duplication cysts is uncommon as is heterotopic mucosa giving rise to peptic ulceration. Mode of presentation depends on whether symptoms due to mass effect or gastrointestinal bleeding predominate. We present a case of iron-deficiency anaemia caused by an enterolith-filled jejunal duplication cyst diagnosed at laparotomy and treated by surgical excision and small bowel resection.

Calcified Jejunal Duplication Cyst

Calcified Jejunal Duplication Cyst

778 ISOLATED BILIOUS VOMITING IN THE FIRST 72 HRS IN TERM NEONATES

A prospective study was undertaken to evaluate the significance of isolated bilious vomiting in the first 72 hours after birth. Over a 4-year period, 45 infants (2/1000 live birth)(mean ±S.D. B.W. 3.2±0.4 kg; G.A. 39.7±1.2 wks) were admitted to NICU because of bilious vomiting without other obvious signs of GI obstruction. The extent of work-up followed a protocol which included serum electrolytes, Ca, plasma glucose, CBC and plain abd. X-ray in all cases, upper or lower GI series and septic workup if indicated. Of the 45 infants, 9 (20%) required surgical intervention (5 malrotation, 1 jejunal atresia, 1 jejunal stenosis, 1 jejunal duplication cyst, 1 infantile myofibromatosis) and 36 (80%) associated with non-surgical conditions (31 idiopathic, 3 meconium plug; 2 left microcolon). There was no sign. diff. between the surg. and non-surg. cases at time of onset of bilious vomiting and onset of meconium passage. All infants with non-surg. condition resumed feeding by 1 week. Surgical cases had sign, higher (p<0.05) incidence of specific findings (4/9) on plain abd. X-ray than the non-surg. cases (1/36). 21/31 with idiopathic bilious vomiting had normal X-ray; 10/31 had non specific dilatation. The validity and predictive values of plain abd. X-ray were: specificity 97%, sensitivity 44%, positive predictive values 80%, negative predictive values 88%. We concluded that: 1) only 20% of infants with isolated bilious vomiting had surgical causes, 2) a positive plain abd. X-ray could predict 80% of surgical cases, a negative finding could not rule out surg. problems.