Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound

Cystic Nontubular Jejunal Duplication Cyst Presenting As Acute Intestinal Obstruction: A Surgical Challenge

Enteric duplication cysts are rare congenital anomalies that present with a vague constellation of symptoms such as vomiting and abdominal distension. Of these, cystic nontubular jejunal duplication cysts comprise an exceedingly small subset. Here, we delineate the case of a two-month-old female baby who presented with symptoms suggestive of acute intestinal obstruction. Radiological workup divulged a cystic lesion, which was subsequently confirmed to be a cystic nontubular jejunal duplication cyst with extensive intestinal wall sharing. Surgical excision was planned but posed a remarkable surgical challenge due to intestinal wall sharing and the cyst's exceedingly fibrotic nature.

Rare diseases of esophagus: Surgical treatment of cysts in adults. Case report

INTRODUCTION AND IMPORTANCE

Esophageal cysts (EC) are congenital, extremely rare malformation. Up to 80% of EC are diagnosed in childhood, therefore, we can find only few clinical observations of EC in adults in literature.

CASE PRESENTATION

During the period from October to December 2019, a successful surgical treatment of 2 patients (1 male and 1 female) with enterogenous and duplication cysts of esophagus was performed at the Clinic of Faculty Surgery at Sechenov University. In both cases thoracic tumors were incidental findings during routine health investigation.

CLINICAL DISCUSSION

Clinical manifestations of ECs are caused by compression or displacement of the adjacent anatomical structures, therefore, most often patients complain of dysphagia, vomiting, pain in the chest, which may be constant or occur during an act of breathing. There are also observations of neurological symptoms due to compression of the radicular nerves The method of choice in the treatment of ECs is their surgical removal.

CONCLUSION

Patients with mediastinal tumors should be treated in specialized hospitals by experienced surgeons who can cope with an unexpected intraoperative finding and carry out the appropriate surgery.

A rare case of perforated gastric duplication cyst associated with gastric diverticulum

A 50-year-old man presented to the emergency department with a 1-day history of severe epigastric pain, vomiting and fever. He had a background of alcohol excess and smoking. The patient was tachycardic and febrile with an elevated white blood cell count and C reactive protein. CT demonstrated extensive upper abdominal free fluid, without free air, with a large cystic lesion arising from the greater curvature of the stomach, and a second smaller cystic lesion arising from the posterior aspect of the gastric fundus. The patient was managed with nasogastric drainage, parenteral nutrition, intravenous antibiotics and proton pump inhibitors, and CT-guided abdominal drainage, with resolution of sepsis, and further outpatient care was transferred to our unit. Follow-up endoscopy demonstrated a diverticulum arising from the posterior aspect of the gastric fundus, with normal mucosa throughout the remaining stomach, while CT showed an additional cystic lesion arising from the greater curvature, with thickening of the adjacent gastric wall consistent with a gastric duplication cyst (GDC). Laparoscopy confirmed a small diverticulum at the fundus, and a large GDC anteriorly with associated omental adhesions consistent with prior perforation-two wedge resections were performed. Histology demonstrated no evidence of malignancy or ectopic mucosa. The patient recovered uneventfully and remained free from recurrent symptoms at 6 weeks postoperatively. GDC is a rare entity, which may be associated with ectopic mucosa, malignant transformation and upper gastrointestinal perforation. No previous report describes the coexistence of a GDC and gastric diverticulum. Herein we describe the investigation and management of this condition, and review the associated peer-reviewed literature.

[Endoscopic treatment of duodenal duplication cyst]

Duodenal duplication cyst (DDC) is a rare form of intestinal malformation (2-12% of all gastrointestinal duplications). There are many difficulties in diagnosis and management of DDC. We present a case of successful endoscopic transluminal treatment of DDC in a 30-year-old female. She complained of epigastric pain, nausea and vomiting, weight loss of 5 kg over the past 3 months. Laparoscopic cholecystectomy for gallstone disease was performed 18 months prior to admission. Examination revealed a cyst 52×60?35 mm in descending part of duodenum. There was a calculus inside the cyst. Transluminal endoscopic cyst fenestration was performed. Histological examination confirmed DDC. According to control duodenoscopy data, cyst was collapsed. The patient remains asymptomatic three months after surgery. DDC is a rare disease of gastrointestinal tract, which should be differentiated first with choledochocele Todani type III and intraluminal duodenal diverticulum. Endoscopic treatment may be an adequate alternative to traditional interventions in some cases.

Applications of Computational Methods in Biomedical Breast Cancer Imaging Diagnostics: A Review

With the exponential increase in new cases coupled with an increased mortality rate, cancer has ranked as the second most prevalent cause of death in the world. Early detection is paramount for suitable diagnosis and effective treatment of different kinds of cancers, but this is limited to the accuracy and sensitivity of available diagnostic imaging methods. Breast cancer is the most widely diagnosed cancer among women across the globe with a high percentage of total cancer deaths requiring an intensive, accurate, and sensitive imaging approach. Indeed, it is treatable when detected at an early stage. Hence, the use of state of the art computational approaches has been proposed as a potential alternative approach for the design and development of novel diagnostic imaging methods for breast cancer. Thus, this review provides a concise overview of past and present conventional diagnostics approaches in breast cancer detection. Further, we gave an account of several computational models (machine learning, deep learning, and robotics), which have been developed and can serve as alternative techniques for breast cancer diagnostics imaging. This review will be helpful to academia, medical practitioners, and others for further study in this area to improve the biomedical breast cancer imaging diagnosis.

Congenital and hereditary cystic diseases of the abdomen

Congenital and hereditary cystic lesions of the abdomen are relatively rare. Correct diagnosis is critical as they may simulate several other benign and malignant acquired diseases of the abdomen. With the correct and appropriate use of imaging, diagnosis may be relatively straightforward and clinical management may be implemented appropriately. The purpose of this article is to describe imaging findings of common and uncommon congenital and hereditary cystic disease of the abdominal organs.

Duodenal Duplication Cysts in Children: Clinical Features and Current Treatment Choices

Background

Duodenal duplication cysts are rare gastrointestinal tract malformations. Most patients experience symptom onset in the first decade of life. This review aims to examine clinical presentation, management strategies and outcomes of duodenal duplication cysts in childhood.

Methods

A Pubmed/Medline (http://www.ncbi.nlm.nih.gov/pubmed/) search in October 2019 for articles published since 1999 using the keywords "duodenal duplication cyst," "child" and "newborn" was carried out. Clinical symptoms, complications, diagnostic examinations, treatment options and outcomes were analyzed and tabulated.

Results

There were 41 citations in the literature providing adequate descriptions of 45 cases of duodenal duplication cysts. The age of presentation ranged from newborn to 18 years. The median interval between initial presentation and definitive diagnosis and treatment was 17 months (range: 2 months to 12 years). Overall, 67% of cases presented with abdominal pain, and 43% were complicated with pancreatitis. Different surgical and endoscopic therapeutic strategies were reported.

Conclusions

Duodenal duplication cysts may be associated with life-threatening complications and/or recurrent symptoms, impairing quality of life. Early recognition of patients who demonstrate suggestive signs and symptoms is important to ensure success of treatment. This review may be useful to highlight the main diagnostic aspects and limit the risk of a delayed diagnosis.

Exploring the neglected segment of the intestine: the duodenum and its pathologies

Herein we reviewed the computed tomography (CT) findings of a spectrum of pathological entities affecting the duodenum. We discuss the CT findings of some congenital, inflammatory, traumatic, and neoplastic pathologies of the duodenum along with the conventional barium studies of selected conditions. Pathologies of this C-shaped intestinal segment, derived from both foregut and midgut, are often overlooked in clinical practice and radiological literature. While congenital anomalies like duplication cysts and diverticula are usually asymptomatic, annular pancreas and malrotation may manifest in the first decade of life. Primary as well as secondary involvement of the duodenum by various disease processes can be evaluated by careful CT technique and proper attention to the duodenum. Among congenital conditions, annular pancreas, duplication cyst, superior mesenteric artery syndrome, midgut volvulus, and diverticula are presented. Duodenal involvement in adenocarcinoma, lymphoma, gastrointestinal stromal tumours, Crohn’s disease, and groove pancreatitis are discussed. Duodenal wall haematoma and traumatic duodenal perforation causing pneumoretroperitoneum in two patients after blunt trauma of the abdomen are also illustrated. CT provides superb anatomic detail and offers high diagnostic specificity for the detection of duodenal pathologies because it allows direct imaging of the intestinal wall, secondary signs of bowel disease within the surrounding mesentery, and abnormal findings in adjacent structures. Primary duodenal malignancies and local extension from adjacent malignancies can be diagnosed by CT reliably. CT also plays a vital role in the diagnosis of traumatic duodenal injury by differentiating between mural haematoma and a duodenal perforation because the latter requires immediate surgical intervention.

Benign lesions of the mediastinum: A review with emphasis on cytology and small biopsy specimens

This review focuses on the diagnosis of select benign processes, ranging from reactive entities to heterotopic tissues to neoplasms, which may occur in the mediastinum. Currently, the mediastinum can be evaluated and biopsied with endoscopic procedures. Therefore, cytopathology specimens, fine needle aspirations, and small biopsies play an important role in the diagnosis of these lesions. In this review, an emphasis is given to relevant clinical presentations, histologic and cytologic findings, differential diagnoses, ancillary testing, and interpretation. Pitfalls are reviewed and discussed in each section. It is important for both surgical pathologists and cytopathologists to be familiar with these entities and their cytologic and histologic features that may be helpful in reaching a diagnosis.

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

Bronchogenic 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.

Esophageal bronchogenic cyst excised by endoscopic submucosal tunnel dissection: A case report

BACKGROUND

Esophageal bronchogenic cyst (EBC) is a rare congenital disease that is difficult to diagnose preoperatively, and treatment remains controversial.

CASE SUMMARY

We report a 53-year-old Chinese woman hospitalized in our hospital following the discovery of a submucosal protruding mass of the esophagus by upper endoscopy. A preliminary diagnosis of EBC was made by endoscopic ultrasonography (EUS), and treatment was accomplished by endoscopic submucosal tunnel dissection (ESTD). The pathological results verified the diagnosis. No scar changes or cystic lesion within the original lesion were found under EUS after a 3-mo follow-up.

CONCLUSION

EUS is valuable for the preliminary diagnosis of EBC and surveillance. ESTD is a safe and effective treatment for EBC. Further evaluation of complications and long-term follow-ups are required.

Caecal duplication cyst leading to intussusception in an adult

Colonic duplication cyst is an uncommon cause of intussusception in adults. We report a case of caecal duplication cyst in a 24-year-old adult with a 3-year history of recurrent abdominal pain mainly in the periumbilical region. CT and MRI of the abdomen showed a lesion suggesting an caecal duplication cyst within an intussuception. The patient underwent diagnostic laparoscopy and was found to have a caecal duplication cyst acting as a lead point for the intusseception for which laparoscopic-assisted resection was performed. The histological examination confirmed the presence of intestinal duplication cyst without any underlying malignancy.

Bowel Imaging in Children: Part 1

The bowel is a challenging abdominal organ to image. The main reason is the variable location, convoluted morphology and motility. A variety of bowel disorders such as congenital, developmental, inflammatory, infectious and neoplastic lesions can affect children and most of them are either unique to this age group or have a distinct clinico-radiological appearance compared to adults. Imaging plays a very important role in characterizing these lesions and further guiding the management. This is the first part of the series on imaging of bowel disorders in children. This article will cover the imaging modalities used for the evaluation of bowel and the imaging features of congenital /developmental disorders.

Recurrent acute pancreatitis caused by duodenal duplication cyst in a young patient

Duodenal duplication cyst is a rare congenital anomaly that develops during the embryonic stage and could remain unknown until the adult age. Although often asymptomatic, duodenal duplication cysts can lead to various clinical scenarios with different degree of severity, from nonspecific abdominal pain up to cholestasis, intussusception or pancreatitis.

A case of duodenal duplication cyst mimicking a pancreatic pseudocyst with intracystic hemorrhage

Background

Duodenal duplication cysts in adults are rare, and a preoperative diagnosis remains difficult because clinical manifestations are nonspecific and variable. We describe a case of a duodenal duplication cyst mimicking a pancreatic pseudocyst with repeated intracystic hemorrhage.

Case presentation

A 47-year-old male who complained of upper abdominal pain and vomiting was referred to our hospital. He was a heavy drinker and had a past history of hospitalization for alcoholic chronic pancreatitis. Plain abdominal computed tomography (CT) showed a cystic lesion of 7 cm in size in the lumen near the second part of the duodenum. The cystic lesion showed high density inside. Gastrointestinal endoscopy revealed that the lumen of the duodenum was deformed by a submucosal tumor-like mass and the endoscope could not pass through it, but active bleeding was not seen in the lumen of the duodenum. On the fourth day of hospitalization, anemia progressed and contrast-enhanced CT demonstrated a high-density spot on the wall of the cystic lesion. A pancreatic pseudocyst complicated with intracystic hemorrhage was preliminarily considered. Angiography was immediately performed, and a pseudoaneurysm was identified in the branch of the anterior superior pancreaticoduodenal artery (ASPDA). Transcatheter arterial embolization (TAE) was performed. Anemia did not progress after that, and follow-up CT showed reduction in the size of the cystic lesion. Afterward, the same symptoms recurred twice and surgical treatment was performed for the pancreatic pseudocyst with repeated intracystic hemorrhage. Macroscopically, a cystic mass of 5 cm in size was adjacent to the second part of the duodenum on the pancreas side. A pinhole-sized communication was identified between the cyst and the duodenum lumen. Microscopically, the cyst wall was composed of gastric mucosa and shared a common proper muscle layer with the duodenum. Chronic ulcers and erosions were seen in the cyst. Based on these findings, a diagnosis of duodenal duplication cyst was made.

Conclusions

Duodenal duplication cysts in adults have seldom been reported and should be considered as a differential diagnosis for a patient with a cystic lesion adjoining the duodenum.

Intestinal duplications: incidentally ileum duplication cyst in young female

Gastrointestinal tract duplication is a rare congenital malformation in young patients and in adults, that occur anywhere from the mouth to the anus and their macroscopic structure may be cystic or tubular.

Intestinal duplication does not show specific symptoms, indeed they can present with a variety of symptoms including abdominal distension and pain, sickness, hemorrhage, chronic respiratory disorders, as well as non-painful abdominal mass. Nonetheless, intestinal duplication can remain completely asymptomatic and be diagnosed as an incidental finding. Presentation with acute complications such as intestinal invagination or mechanical occlusion is quite rare.

We present a case of asymptomatic ileum duplication cyst in young female who referred to the emergency department for trauma and was screened by eco-Focus Assessment Sonography for Trauma (eco-FAST), followed by MR and CT.

The patient underwent ileal resection and prophylactic appendicectomy with ileo-cecal termino-lateral anastomosis. In this case, the intestinal duplication cyst was an asymptomatic incidental finding.

Gastric duplication cyst with hemoptysis: an unusual presentation

Gastrointestinal duplications are rare developmental anomalies that may occur at any level from the oral cavity to the rectum, with the ileum being the most common site. Gastric duplications are rare gastrointestinal duplications. Various theories have been proposed for the development of duplication cysts; however, there is no single theory that explains all types of duplications. Complete removal is the treatment of choice to avoid the risk of possible complications and malignant transformation. Most cases present within the first year of life. The clinical presentation of gastric duplications can be highly variable; however, they usually present with abdominal pain and a lump. Clinical presentation with hemoptysis is rare. Only one such case has been reported previously. We describe a three-year-old male with gastric duplication who presented with hemoptysis.

Gastric duplication cyst communicating to accessory pancreatic lobe: A case report and review of the literature

BACKGROUND

The combination of a gastric duplication cyst and duplicated part of the pancreas is an extremely rare developmental defect. The incidence in the population, or the clinical impact thereof, has not been uncovered. Symptoms are unspecific. Surgery is the treatment of choice. Timely diagnostics are of utmost importance, albeit they might be challenging at times. Being so rare, case reports are currently the only relevant source of information about the condition. Therefore each published finding is of a clinical impact.

CASE SUMMARY

Our work describes the case of a 22 year-old patient, who developed idiopathic acute pancreatitis. A computed tomography scan discovered liquid collection between the antrum of the stomach and the head of the pancreas. Initially, the collection was thought to be a pancreatic pseudocyst. Endoscopic ultrasound-guided transgastric drainage showed to have only a temporary therapeutic effect. Magnetic resonance cholangiopancreatography showed an accessory pancreatic lobe with a separate duct system. The accessory pancreatic lobe exited the body of the pancreas and was in contact with the cystic collection. The patient was indicated for surgical resection. Within the surgery, an en bloc resection of the accessory pancreatic lobe was performed with the antrum of the stomach containing the gastric duplication cyst. No complications were observed in the surgery or thereafter. In the five months follow-up period, the patient was completely symptom free. Histopathological findings confirmed the gastric duplication cyst communicating to accessory pancreatic lobe.

CONCLUSION

This developmental defect is extremely rare. It can cause recurrent acute pancreatitis. Diagnostics are challenging. Surgery is treatment of choice.

Enteric duplication cysts in children: varied presentations, varied imaging findings

Enteric duplication cysts (EDCs) are rare congenital malformations formed during the embryonic development of the digestive tract. They are usually detected prenatally or in the first years of life. The size, location, type, mucosal pattern and presence of complications produce a varied clinical presentation and different imaging findings. Ultrasonography (US) is the most used imaging method for diagnosis. Magnetic resonance (MR) and computed tomography (CT) are less frequently used, but can be helpful in cases of difficult surgical approach. Conservative surgery is the treatment of choice. Pathology confirms the intestinal origin of the cyst, showing a layer of smooth muscle in the wall and an epithelial lining inside, resembling some part of the gastrointestinal tract (GT). We review the different forms of presentation of the EDCs, showing both the typical and atypical imaging findings with the different imaging techniques. We correlate the imaging findings with the surgical results and the final pathological features. TEACHING POINTS: • EDCs are rare congenital anomalies from the digestive tract with uncertain pathogenesis. • More frequently, diagnosis is antenatal, with most EDCs occurring in the distal ileum. • Ultrasonography is the method of choice for diagnosis of EDCs. • Complicated EDCs can show atypical imaging findings. • Surgery is necessary to avoid complications.

Application of endoscopic ultrasound-guided-fine needle aspiration combined with cyst fluid analysis for the diagnosis of mediastinal cystic lesions

BACKGROUND

Mediastinal cystic lesions account for approximately 15-20% of all mediastinal masses and are difficult to differentiate because of similar imaging manifestation. The aim of this study was to differentiate mediastinum cystic lesions through endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) and parameters from cyst-fluid analysis.

METHODS

Over a period of eight years, 37 patients suspected with mediastinal cystic lesions were assessed. Cyst fluid was collected via EUS-FNA and further examined using cytological and biochemical techniques. Definitive diagnosis was established based on cytology, surgical pathology, and/or clinical follow-up.

RESULTS

Based on the final pathological reports or long-term follow-up, 19 patients were diagnosed with benign cysts, 14 with benign or malignant tumors, 2 with tuberculosis, 1 with an abscess, and 1 with a pancreatic pseudocyst. Computed tomography or magnetic resonance imaging mistakenly distinguished eight cases as solid masses (27.03%), but EUS revealed cystic characteristics. Carcinoembryonic antigen and lactate dehydrogenase (LDH) were evaluated from the cyst fluid obtained by EUS-FNA. There was no statistically significant difference in carcinoembryonic antigen values between benign and malignant cysts; however the average LDH value in the malignancy group was significantly higher than in the benign group.

CONCLUSION

EUS-FNA showed great potential for differentiating mediastinal lesions by combining imaging manifestation and cytological examination. The elevated LDH value from cyst fluid chemical analysis could be used as an auxiliary indicator for diagnosing malignancy.

54-cm enteric duplication cyst in a 13-year-old female

Enteric duplication cyst is a very rare condition, the affected individual may be asymptomatic. It has serious complications, on top of which is a malignant transformation tendency. To avoid these complications, resection of the duplication seems to be mandatory, even if it is an incidental finding.

Duplication cyst of the pylorus: a rare cause of gastric outlet obstruction

Alimentary tract duplications are a rare congenital malformation. They can present with varied symptoms owing to the locality of the duplication, along the gastrointestinal tract. Out of these duplications, the ones along the pylorus are the most rare. These are usually only diagnosed intraoperatively, as it is not a common differential on imaging due to its rarity. In lieu of the literature currently available, pyloric duplication cyst can present anytime from 1 week of age to 5 years, with some cases being detected antenatally due to the prevalence of regular antenatal scanning. Surgery remains the main stay of treatment with the goal of complete excision of the cyst and complete removal of the cyst mucosal lining. We report the case of a 5-year-old girl, which to our knowledge is the first ever reported case from Karachi, Pakistan.

Adenocarcinoma Arising from a Gastric Duplication Cyst

Gastric duplication cysts are rare congenital anomalies, and malignant transformation has only been reported in 11 cases. A healthy 57-year-old woman presented with abdominal discomfort, and computed tomography revealed a 5.8 × 6.6 × 8.2 cm mass at the gastric fundus. On endoscopic ultrasound, the mass was mostly hypoechoic with anechoic cystic cavities arising from the submucosal layer. Fine-needle aspiration was suspicious for adenocarcinoma. Surgical pathology confirmed high-grade adenocarcinoma, clear cell cytology arising from a foregut duplication cyst. Endoscopic ultrasound is underutilized in the evaluation duplication cysts and should be considered in routine workup.

Endoscopic Treatment of Colonic Duplication Cyst: A Case Report and Review of the Literature

Colonic duplication cysts are a rare congenital abnormality commonly presenting before two years of age. In adults, it has been rarely reported, most often as an incidental finding. We report a case of 42-year-old female complaining of constipation and lower abdominal pain. Patient's CT scan of the abdomen showed a cystic lesion at hepatic flexure and the diagnosis was confirmed endoscopically using endoscopic ultrasound (EUS). The cyst was treated employing hot snare to expose the cyst cavity. On our literature search, there have been no reported cases of colonic duplication cyst treated endoscopically. We here discuss incidence, diagnosis, characteristics, and treatment of duplication cysts with special emphasis on endoscopic therapy.

Intrapancreatic Enteric Duplication Cyst Masquerading as Groove Pancreatitis

Intrapancreatic enteric duplication cysts are exceedingly rare, and the clinical presentation varies. We present a 48-year-old man with significant alcohol and tobacco abuse and a diagnosis of groove pancreatitis complicated by a pancreatic duct stricture, pseudocyst, and recurrent biliary obstruction. Due to failure of endoscopic therapy and concerning findings on endoscopic ultrasound with negative pathology, he underwent a pancreaticoduodenectomy. Pathology revealed an intrapancreatic enteric duplication cyst, minimal chronic pancreatitis changes associated with pancreaticobiliary strictures, and no evidence of malignancy. This rare diagnosis should be considered in the differential for patients with idiopathic recurrent pancreaticobiliary duct strictures and pancreatic pseudomasses.

Giant retrocardiac foregut duplication cyst presenting with left atrial compression and palpitations

A 35-year-old man presented with a 3-month history of palpitations and shortness of breath. An ECG showed premature atrial contractions and episodes of supraventricular tachycardia. A subsequent echocardiogram showed a retrocardiac cystic mass that was compressing the left atrium. A CT scan confirmed these findings by showing a large left-sided posterior mediastinal cyst compressing the left atrium and pulmonary veins. The cyst was successfully excised from the retrocardiac position via left thoracotomy after which there was complete resolution of the palpitations. Histopathology showed it to be a mediastinal cyst, most likely a foregut duplication of the enterogenic variant. This is an extremely unusual case of foregut duplication cyst presenting with compression of the left atrium and pulmonary veins leading to atrial arrhythmias.

Esophageal duplication cyst with hemivertebrae: A case report and literature review

BACKGROUND

Esophageal duplication cysts (EDCs) are rare congenital anomalies that can be associated with symptomatic spinal abnormalities, but presentations due to EDC symptoms are rarely found in the presence of spinal abnormalities.

CASE SUMMARY

A 6-month-old infant weighing approximately 5.0 kg presented with a 2-month pulmonary infection and more recent difficulty swallowing and nutritional intolerance that did not improve with medical treatment. Contrast-enhanced chest computed tomography showed a well-defined, mediastinal, homogeneous, low-density cystic mass of 11.9 × 5.5 × 5.1 cm, compressing the liver and bending the trachea forward. Hemivertebrae were present (T4 and T3). Diagnostic laparoscopy was performed, but was converted to open surgery. After ensuring that the cyst was not within the abdominal cavity, thoracotomy was performed, and the cyst was completely resected. Pathophysiological examination revealed an EDC. The patient recovered well, without symptoms 6 months later.

CONCLUSIONS

Overall, noninvasive imaging and diagnostic procedures may not be sufficient to define the exact location of an EDC. Although hemivertebrae were present, they were asymptomatic and did not require treatment; only the EDC induced nonspecific symptoms that disappeared after surgery.

Evaluation of Transabdominal Ultrasound with Oral Cellulose-Based Contrast Agent in the Detection and Surveillance of Gastric Ulcer

The aim of this study was to assess the role of transabdominal ultrasound with cellulose-based oral contrast agent (TUS-OCCA) in the detection and surveillance of gastric ulcer. The study was approved by the institutional review board at Shengjing Hospital of China Medical University. A total of 124 consecutive patients with benign gastric ulcer diagnosed by gastroscopy and biopsy were enrolled. Serial TUS-OCCA (approximately 1 exam every 2 wk) was performed to monitor the effects of treatment, and additional interventions were planned according to the results. TUS-OCCA detected gastric ulcer in 76% of patients (94 of 124). The detection rates for lesions of ≤5 mm, lesions of 5-10 mm, lesions of 10-15 mm and lesions >15 mm were 32% (10 of 31), 77% (27 of 35), 96% (25 of 26) and 100% (32 of 32), respectively. The detection rates for lesions located in the antrum, angle and body were 70%, 84% and 85%, respectively. Among 30 undetected lesions, which ranged 2-13 mm in size, 11 were at the antrum, 9 at the angle, 3 in the body, 6 at the cardia and 1 at the fundus. During the follow-up period, patients underwent a mean of 3.8 TUS-OCCA examinations (range 2-7), and ulcers were healed after 8 wk (range 2-12 wk) of standard therapy in 76 patients. Eighteen patients who did not show improvement after standard therapy underwent repeat gastroscopy with biopsy. Repeat biopsy was positive for gastric cancer in 4 of these: 2 of the remaining 14 were diagnosed with gastric cancer at gastrectomy, and 12 were diagnosed with chronic benign ulcer. These results indicate that serial TUS-OCCA can be used for close monitoring during routine treatment of gastric ulcers that are detectable by TUS-OCCA and that monitoring by TUS-OCCA can guide additional interventions. A non-invasive follow-up program based on TUS-OCCA can also help to detect gastric cancers that have been misdiagnosed as benign ulcers at the initial endoscopic biopsy.

[A Case of Hemorrhage of an Esophageal Duplication Cyst Improved by Endoscopic Drainage]

Esophageal duplication cyst is a rare congenital gastrointestinal malformation. It is the second most common duplication cyst following small bowel duplication cyst in the gastrointestinal tract. Patients with an esophageal duplication cyst are generally asymptomatic; however, some patients may present the following symptoms: dysphagia, chest pain, stridor, unproductive cough, and epigastric discomfort by compression of the surrounding structures. Surgical removal is the treatment of choice in symptomatic cases and can be considered in asymptomatic cases if they are at risk for developing complications, such as ulceration or perforation. Herein, we report a case of hemorrhage of an esophageal duplication cyst, which was improved by endoscopic drainage.

Esophageal duplication and congenital esophageal stenosis

Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment.