Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations

Peritoneal metastatic adenocarcinoma possibly due to a gastric duplication cyst: a case report and literature review

Background

Gastric duplication cysts are rare congenital abnormalities, and malignant transformation of these duplications is also thought to be rare.

Case presentation

During a routine health checkup, a 28-year-old man underwent abdominal sonography followed by computed tomography (CT) with contrast agent, which revealed a cystic lesion with no enhancement. Laparoscopic surgery showed a 10 × 10 cm cyst adhering to the gastric corpus. However, attempts to remove the lesion en bloc were unsuccessful, and the ruptured cyst had contaminated the peritoneal cavity. Gastric duplication was diagnosed from microscopic examination of the cyst. Seven months later, the patient suffered a progressive increase in ascites, and repeated cytological analysis showed small nests of adenocarcinoma cells, with primary lesion unknown. Diagnostic laparoscopy showed multiple white nodules scattered over the surface of the liver, greater omentum, and peritoneum. Biopsy of the omental nodules confirmed adenocarcinoma, while carcinomatosis was diagnosed in the peritoneum.

Conclusions

Clinical presentation and chronological developments indicated that the malignancy probably originated from the gastric duplication cyst. This case highlights the importance of accurate preoperative diagnosis and optimal surgical management for gastric duplication as well as considering the potential existence of malignant transformation during surgical evaluation of adult patients with gastric duplication cysts.

Congenital lymphangiomatosis and an enteric duplication cyst in a young dog

A two-year-old female poodle with abdominal distention was diagnosed with concurrent enteric duplication cyst and lymphangiomatosis. Both lesions were shown as cystic structures, but some characteristic features of enteric duplication cyst were identified including a thick cyst wall and shared blood supply with the duodenum. Although it was challenging to discriminate between the types of cyst based on diagnostic imaging, this report describes the characteristics of each type of lesion using several different imaging modalities.

Thoracoabdominal duplication symptomatic on both sides: a case report

Thoracoabdominal foregut duplications account for less than 2% of all gastrointestinal duplications. Here, we report a case of thoracoabdominal duplication cyst in an eight-month old boy who presented with both respiratory and abdominal complaints. Excision of both thoracic and abdominal extensions of the thoracoabdominal duplications in the same session is an appropriate and safe option to prevent possible complications.

Duplication cyst with esophageal mucosa at the floor of the mouth: a case report

Intraoral localization of alimentary tract duplication is extremely rare. We report a duplication cyst at the floor of the mouth, lined by esophageal epithelium and treated successfully by surgical excision. To our knowledge, this is the third case of intraoral enteric duplication cysts lined with esophageal epithelium reported in the literature.

Diagnosis and treatment of choledochoceles

Choledochoceles are cystic dilatations of the intraduodenal portion of the common bile duct. Although often classified as Type III biliary cysts, choledochoceles have distinctive demographic and anatomic features and a lower risk of malignancy than other types of choledochal cysts. Type A choledochoceles are cystic dilatations of a segment of the intra-ampullary bile duct and are located proximal to the ampullary orifice. Type B choledochoceles are diverticula of the intra-ampullary common channel and are located distal to the ampullary orifice; they can be distinguished from duodenal duplication cysts both anatomically and histologically. Both types of choledochocele may present with pancreatitis, biliary obstruction, or nonspecific gastrointestinal symptoms. Cross-sectional imaging, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography are useful for diagnosis. Choledochoceles may be drained or resected endoscopically. Surveillance for dysplasia should be considered for lesions that are not resected.

Visual diagnosis: 12-year-old girl with constipation and rectal bleeding

Rectal duplication cysts are rare, thought to be due to defects in embryologic development, and often associated with other structural abnormalities. Clues to the existence of a rectal cyst are mainly due to bowel compression and presence of ectopic gastric mucosa within the cyst, leading to rectal bleeding. The diagnosis of a rectal duplication cyst requires a high index of suspicion. Confirming the diagnosis can be difficult based on the location of the cyst. Efforts to confirm the diagnosis include digital rectal examination, computed tomography, magnetic resonance imaging, ultrasonography, and Meckel scan. Surgical resection is the treatment of choice, especially because of the cyst’s potential for malignant transformation. Because of the cyst’s proximal location to the nerves innervating the anal canal and sphincters, surgical resection can lead to fecal incontinence.

Isolated duodenal duplication cyst presenting as a complex solid and cystic mass in the upper abdomen

Duodenal duplication cysts are a rare subtype of gastrointestinal duplications cysts. Approximately 5% of gastrointestinal duplication cysts occur in the duodenum. An 18-year-old woman presented with epigastric pain and a subjective abdominal bulge. A computed tomography scan was subsequently performed and showed a solid and cystic mass with wall calcifications in the lesser sac of the upper abdomen. A duodenal duplication cyst was found unexpectedly on histopathologic analysis. This was also an unusual case as there was no evidence of malignancy. Four years after surgery, the patient remains asymptomatic. We present a brief literature review on duodenal duplication cysts and discuss its differential diagnosis.

A completely isolated intestinal duplication cyst mimicking ovarian cyst torsion in an adult

Intestinal duplications are rare congenital anomalies that can occur anywhere in the gastrointestinal tract. They are most commonly located in the ileum and are usually detected in infancy or early childhood. Duplicated segments are usually firmly attached to and sometimes communicate with the normal gastrointestinal tract. Rarely, intestinal duplications are completely isolated, thus not associated at all with any part of the gastrointestinal tract. Such duplications do not share a common blood supply with the adjacent normal intestinal segment, unlike the usual form of duplication, but rather have a separate vascular pedicle. Reports of completely isolated duplication cysts in adults are extremely rare; we found only five such reports in the English-language medical literature. Here, we report a case of a completely isolated duplication cyst 12 cm long in an adult female. The cyst had no connection to any part of the intestinal tract and had a dedicated vascular pedicle.

Use of negative contrast computed tomography for diagnosis of a colonic duplication in a dog

A 24-week-old dog was presented with recurrent rectal prolapse because of colonic duplication. Colonic duplication is an extremely uncommon congenital abnormality, with only six cases reported in veterinary medicine, one diagnosed at necropsy and five after barium enema, colonoscopy, abdominal ultrasound, exploratory laparotomy either alone or in combination. In this case, these techniques failed to identify the abnormality and diagnosis was ultimately achieved via negative contrast computed tomography. The evaluation generated by the computed tomography images allowed a refined surgical approach. To the authors' knowledge, negative contrast computed tomography has not yet been reported in the veterinary literature to diagnose gastrointestinal pathologies. Colonic duplication in this case was treated by removal of the intercolonic septum via colotomy.

Benign oesophageal diseases: a review of the CT findings

A variety of benign conditions can affect the oesophagus, both primarily and secondarily. Traditionally fluoroscopic oesophagography and endoscopy have formed the mainstay for investigating oesophageal diseases. Increasing use of cross-sectional imaging means that many such diseases and their thoracic complications are now detected at computed tomography (CT), which is very often the first imaging tool. This review describes the CT manifestations of a range of benign oesophageal conditions and discusses the role of CT in their evaluation.

Colorectal duplication with prostatorectal fistulae

Tubular colonic duplications are rare malformations and its association with prostatorectal fistula is extremely rare with only one case reported to date. We report the successful management of an 8 year old child with communicating tubular colonic duplication with prostatorectal fistulae. Tubular colonic duplications may be difficult to diagnose due to varied presentations, therefore a high degree of suspicion should be present while managing children with isolated congenital recto urinary fistulas.

Duplicated gall bladder with duodenal duplication cyst

A four year old boy with a duplicated gall bladder communicating with a duplication cyst of the duodenum is reported for the first time in the literature. It is also reported for the absence of any connection with the biliary system.

Recurrent acute pancreatitis and massive hemorrhagic ascites secondary to a duodenal duplication in a child: a case report

Introduction

Duodenal duplication is a rare congenital malformation and has been reported as a rare cause of recurrent acute pancreatitis. Hemorrhagic ascites has been reported in only one case of duodenal duplication.

Case presentation

An 11-year-old Chinese girl presented with abdominal pain, hematemesis and dark stools. On admission, an abdominal examination revealed a moderately distended abdomen with diffuse tenderness. Biochemical investigations showed increased serum levels of amylase, lipase, and urine amylase. An abdominal computed tomography scan and magnetic resonance imaging scan revealed an enlarged and heterogeneous pancreas with poorly delineated borders. There was a cystic lesion measuring 25mm × 48mm × 28mm, located between the descending portion of her duodenum and the head of her pancreas. There were massive effusion signals in her abdominal cavity. An exploratory laparotomy was performed. A tubular cyst measuring 32mm × 52mm × 30mm was found in the second part of the duodenum, next to the head of her pancreas. The anterior wall of the duplication cyst was resected and anastomosis of the remaining cyst to the duodenum was performed for drainage. Histopathological examination of the excised cyst wall showed duodenal mucosa, submucosa and muscle coats, indicative of a duodenal duplication.

Conclusions

It is important to be aware of duodenal duplication when evaluating a patient with recurrent acute pancreatitis accompanied by massive hemorrhagic ascites.

[Congenital esophageal duplication cysts: progressive dysphagia in adulthood]

Esophageal duplications are congenital abnormalities of the foregut. We present the case of a 33-year-old woman suffering from progressive dysphagia who had surgery for esophageal duplication. The following three criteria define the cystic lesion: an intimate attachment to the esophageal wall, the presence of a smooth muscle coat and a mucosal lining consisting of squamous and/or ciliated respiratory epithelium. Diverticula, bronchogenic cysts and cystic neoplasms have to be considered in the differential diagnosis. Congenital cystic esophageal duplication is a rare cause of dysphagia in adulthood.

Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease

The use of cross-sectional imaging techniques for the noninvasive evaluation of small-bowel disorders is increasing. The effectiveness of magnetic resonance (MR) enterography for the evaluation of Crohn disease, in particular, is well described in the literature. In addition, MR enterography has an evolving though less well documented role to play in the evaluation of other small-bowel diseases, including various benign and malignant neoplasms arising in isolation or in polyposis syndromes such as Peutz-Jeghers, inflammatory conditions such as vasculitis and treatment-induced enteritis, infectious processes, celiac disease, diverticular disease, systemic sclerosis, and bowel duplication. MR enterography may be useful also for the evaluation of intermittent and low-grade small-bowel obstructions. Advantages of MR imaging over computed tomography (CT) for enterographic evaluations include superb contrast resolution, lack of associated exposure to ionizing radiation, ability to acquire multiplanar primary image datasets, ability to acquire sequential image series over a long acquisition time, multiphasic imaging capability, and use of intravenous contrast media with better safety profiles. MR enterography also allows dynamic evaluations of small-bowel peristalsis and distensibility of areas of luminal narrowing and intraluminal masses by repeating sequences at different intervals after administering an additional amount of the oral contrast medium. Limitations of MR enterography in comparison with CT include higher cost, less availability, more variable image quality, and lower spatial resolution. The advantages and disadvantages of MR enterography performed with ingestion of the oral contrast medium relative to MR enteroclysis performed with infusion of the oral contrast medium through a nasoenteric tube are less certain.

Infected completely isolated enteric duplication cyst management with percutaneous drainage and surgical excision after retreat of infection: a case report

Duplication cysts (DCs) of alimentary tract are rare congenital malformations. They are firmly attached to the wall of the gastrointestinal tract and they are supplied by surrounding mesenteric blood vessels. More than 80% of cases occur before the age of two years and only a minority of cases present in adulthood. “Completely isolated duplication” of the alimentary tract is an extremely rare variety of gastrointestinal duplications. They have gastrointestinal epithelial and wall characteristics without an anatomic association with the alimentary tract. Their main characteristic is that they have their own blood supply. A 20-year-old male was admitted to our department with symptoms persisting for a period of one week prior to admission, which included abdominal pain, fever, and a palpable abdominal mass. CT revealed an unexplained intraperitoneal abscess. This case represents a rare clinical example of infected isolated duplication cyst managed with percutaneous drainage and surgical excision of the cyst 3 weeks later. To the best of our knowledge, this is the first reported case to use this approach.

Acute recurrent pancreatitis secondary to the rare association of a duodenal duplication cyst and a pancreas divisum

Duodenal duplication cysts are rare congenital anomalies that can cause acute pancreatitis. Pancreas divisum is also a congenital anomaly, often discovered incidentally, but is considered a possible cause of acute pancreatitis. We report the case of the combination of both anomalies causing recurrent episodes of acute pancreatitis in a young man. Endoscopic treatment by partial excision of the cyst with a polypectomy snare and sphincterotomy of the minor papilla was successful.

Duodenal duplication cyst in a 52-year-old man: A challenging diagnosis and management

INTRODUCTION

Duodenal duplication is a rare congenital malformation. Although more frequent in childhood, it may rarely be observed in adulthood. Pre-operative diagnosis can be difficult.

PRESENTATION OF CASE

We report the case of a 52-year-old man with a duodenal duplication cyst, who was misdiagnosed even after a primary surgery. Definitive treatment needed an extensive diagnostic workup and a second delicate operation.

DISCUSSION

This article discusses the incidence of duodenal duplications, their types, their clinical presentations, the radiologic and diagnostic features along with different therapeutic options.

CONCLUSION

Duodenal duplication should always be one of the differential diagnoses proposed when approaching upper abdominal cystic formations.

Retroperitoneal duplication cyst with a fistulous tract to the vagina: a case report

OBJECTIVES

To describe a rare case of a retroperitoneal duplication cyst that fistulized to the vagina.

METHODS

Case description and discussion of a patient found to have an intestinal duplication cyst.

RESULTS

A patient presented for a laparoscopic hysterectomy because of menorrhagia and a fibroid uterus. She also complained of recurrent urinary tract infections (UTIs) and a vaginal discharge. A retroperitoneal intestinal duplication cyst that fistulized to the vagina and caused her recurrent UTIs was identified. Surgical resection of the cyst resolved her complaint of recurrent UTIs.

CONCLUSIONS

Retroperitoneal intestinal duplication cysts are rare congenital anomalies with vague clinical manifestations. The finding of a fistulous communication to the vagina originating from such a structure can be associated with recurrent UTIs.

Periampullary duodenal duplication cyst masquerading as a choledochocele

Enteric duplication cysts are rare congenital anomalies of unclear etiology. While they can occur anywhere in the gastrointestinal tract, they typically occur in the ileum or ileocecal region and very rarely in the duodenum. Here, we report a case of a periampullary duodenal duplication cyst in a 13-year-old male who presented with clinical and laboratory evidence of small bowel obstruction, hepatitis, and pancreatitis. Based on radiologic imaging, the patient was thought to have a type III choledochal cyst (choledochocele) within the duodenal lumen. Intraoperative findings and postoperative pathological evaluation, however, revealed that the lesion was a duodenal duplication cyst masquerading as a choledochal cyst. Interestingly, the duplication cyst was communicating with the common bile duct, simultaneously causing biliary and small bowel obstruction.

Congenital double pylorus

The double pylorus is an uncommon finding and maybe congenital due to gastrointestinal duplication abnormality or more commonly secondary to peptic ulcer disease. The case we present is an elderly patient with mild dyspeptic symptoms who had an upper endoscopy as part of her investigative workup. The congenital double pylorus, being asymptomatic, may often go undetected. It is sometimes found incidentally on upper endoscopy, but needs no directed therapy. It is not associated with any specific complication.

Intramural carcinoma of the oesophagogastric junction

Most oesophageal carcinomas (>70%) are squamous cell carcinomas (SCC) arising from the surface epithelial lining. In the gastro-oesophageal junction (GEJ) adenocarcinomas occur in the setting of Barrett oesophagus (BE). These carcinomas typically present with surface ulceration. The authors report a rare case of a SCC of the GEJ with completely intramural growth underneath intact non-dysplastic oesophageal squamous epithelium and BE without dysplasia. The sharply demarcated tumour was located in the muscularis propia with infiltration of perioesophageal tissue nearly reaching the diaphragm. Intramural squamous carcinomas are very rare with only three reported cases. In this study, the authors discuss this finding and review the relevant literature. Intramural carcinomas are a diagnostic challenge for clinicians and pathologist, since preoperative biopsies mostly fail to establish the diagnosis and surgical explorations must be considered.

Perinatally discovered complete tubular colonic duplication associated with anal atresia

Complete tubular colonic duplication (CTCD) is exceedingly rare. The association of CTCD with an anorectal malformation is unusual. This malformation may be found unexpectedly at laparotomy. We present 3 cases of surgically proven neonate CTCD discovered at laparotomy for anal atresia. We reviewed the mode of clinical presentation, the imaging, and laparotomy findings. Our series illustrates that this rare disease presents perinatally in association with anal atresia, with or without other associated anomalies.

Usual and unusual causes of pediatric gastric outlet obstruction

Gastric outlet obstruction in children encompasses a spectrum of disorders that extends beyond hypertrophic pyloric stenosis. Each condition can result in the clinical syndrome of persistent nonbilious vomiting, which can progress to dehydration and electrolyte imbalances. This paper reviews the spectrum of both the common and uncommon entities that cause partial or complete gastric outlet obstruction and their imaging appearances. The correct diagnosis of those with gastric outlet obstruction can be achieved by combining clinical presentation with appropriate imaging, leading to optimal and timely patient management.

Persistent umbilical discharge from an omphalomesenteric duct cyst containing gastric mucosa

Umbilical discharge in infancy is often attributed to infection or an umbilical granuloma. It is important to investigate if such a discharge is due to an underlying congenital abnormality because corrective surgical intervention may then be required. We present the first case of an infant with a persistent umbilical discharge from an omphalomesenteric duct cyst. The discharge was associated with periumbilical dermatitis. The dermatitis was most likely due to irritation of the skin by gastric acid produced by the ectopic gastric mucosa contained in the omphalomesenteric duct cyst. Both discharge and dermatitis resolved after surgical removal of the cyst.

Gastric duplication cyst removed by endoscopic submucosal dissection

Duplication cysts are uncommon congenital malformations that may occur anywhere throughout the alimentary tract. The stomach is an extremely rare site of occurrence. Here, we report a case of gastric duplication cyst initially presenting with a gastric submucosal tumor. A 28-year-old man complained of dyspepsia lasting 1 year and upper endoscopy revealed an ellipsoid submucosal tumor at the greater curvature of the antrum. We intended to use the injection-and-cut technique: however, after saline injection, the lesion was dented and impossible to grasp with a snare. Therefore, we decided to perform endoscopic submucosal dissection and removed the tumor without complication. Histopathology revealed a 0.6×0.6 cm-sized duplication cyst, and there has been no recurrence in 2 years.

Acute respiratory distress caused by esophageal duplication canceration in an adult

Esophageal duplication (ED) in adults is rare, and ED canceration is very rare. We report a case of acute respiratory embarrassment caused by ED with squamous carcinoma in a 39-year-old man and a review of the literature.

Adenocarcinoma arising from a gastric duplication cyst

Malignant transformation in a gastric duplication cyst (GDC) is extremely rare, with only eight reported cases to date. An additional case of an adenocarcinoma arising from a GDC in a 25-year-old male is reported here. Ultrasonography and computed tomography (CT) scans detected a well-defined cyst arising from the greater curvature of the stomach. The patient was submitted to en-bloc resection of the mass with total gastrectomy and regional lymphadenectomy. At the time of laparotomy, the unilocular cyst was full of a thick substance and had no association with the gastric lumen. Microscopic examination revealed that the cystic mass had a well-formed cyst wall with an inner mucosal lining, submucosal layer, muscularis propria, and outer serosal layer. The inner cyst was lined by gastric mucosa. A mediated differentiated adenocarcinoma was found in the duplication cyst, which had invaded the serosa of the cyst wall and the gastric muscular wall. To our knowledge, this is the youngest and only asymptomatic patient in whom neoplastic GDC changes have been reported.

Duodenal duplication complicating laparoscopic cholecystectomy: a case report

Duplication of the gastrointestinal tract is an uncommon congenital abnormality that can occur anywhere from the tongue to the anus. The duodenum is the least common location for such an abnormality, which usually manifests as a spherical cyst-like structure that can present as mechanical bowel obstruction, biliary obstruction or an abdominal mass, among other presentations. Such abnormalities are typically detected during childhood but here we report a case of duodenal duplication discovered as a complication of laparoscopic cholecystectomy in an adult.

Large tubular colonic duplication in an adult treated with a small midline incision

Tubular colonic duplication presenting in adults is rare and difficult to diagnose preoperatively. Only a few cases have been reported in the literature. We report a case of a 29-year-old lady presenting with a long history of chronic constipation, abdominal mass and repeated episodes of abdominal pain. The abdominal-pelvic computed tomography scan showed segmental bowel wall thickening thought to be small bowel, and dilatation with stasis of intraluminal content. The provisional diagnosis was small bowel duplication. She was scheduled for single port laparoscopic resection. However, a T-shaped tubular colonic duplication at sigmoid colon was found intraoperatively. Resection of the large T-shaped tubular colonic duplication containing multiple impacted large fecaloma and primary anastomosis was performed. There was no perioperative complication. We report, herein, the case of a T-shaped tubular colonic duplication at sigmoid colon in an adult who was successfully treated through mini-laparotomy assisted by single port laparoscopic surgery.

Sonographic diagnosis of gastric duplication cyst communicating with the gastric lumen

Gastric duplication cysts are rare congenital anomalies, which account for about 7% of all enteric duplications. We report the sonographic findings of a rare case of gastric duplication cyst, communicating with the gastric lumen in a 30-year-old woman.

Communicating tubular duplication of upper esophagus-a rare occurrence

Duplications of esophagus are commonly classified into two types, tubular and cystic. Tubular duplication of esophagus is a rare occurrence and is much less common than cystic duplication of foregut. Most esophageal duplications are located in the lower third of the esophagus. A cervical esophageal duplication is extremely rare. Esophageal duplications have been reported twice as commonly on the right as on the left. We report a case of incidental finding identified on computed tomography of communicating tubular esophageal duplication involving the left side of the upper esophagus in a tuberculosis patient that was subsequently confirmed on barium swallow test.

Recurrent acute pancreatitis secondary to a duodenal duplication cyst in an adult. A case report and literature review

Duodenal duplication cysts are rare congenital abnormalities that are most commonly diagnosed in infancy and childhood. However, in rare cases, the lesion can remain asymptomatic until adulthood. An extremely rare case of a previously healthy adult patient with recurrent acute pancreatitis, who was diagnosed with a duodenal duplication cyst is presented. At laparotomy, a duplication cyst measuring 4.8 cm x 4 cm x 4 cm was found adjacent to the ampulla of Vater. A partial cyst excision and marsupialization into the duodenal lumen was performed. The patient is healthy and asymptomatic four years after surgery. The present case illustrates the necessity of considering a duodenal duplication cyst in the differential diagnosis of recurrent acute pancreatitis in previously healthy adults.

Thoracoscopic resection of thoracic esophageal duplication cyst containing ectopic pancreatic tissue in adult

Esophageal duplication cyst is a rare congenital anomaly. They can be associated with other congenital anomalies, such as spinal abnormalities, and tracheoesophageal fistulas. In adults, almost of the patients with esophageal duplication cyst is asymptomatic and accidentally diagnosed by chest X-ray or computed tomography. However, cysts may become symptomatic owing to complications such as esophageal stenosis, respiratory system compression, rupture, infarction, or malignancy. Complete surgical resection is the standard treatment even in patients with asymptmatic cysts. Traditional approach for resection is via thoracotomy. But, the thoracoscopic approach makes more indicate for mediastinal diseases, because of minimally invasive for patients. We describe a case with esophageal duplication cyst, which contained the ectopic pancreatic tissue in the solid portion, resected under the thoracoscopic approach in adult.

Communicating esophageal tubular duplication in a newborn infant

We describe a communicating esophageal duplication in a newborn infant, without any other associated congenital anomalies. The diagnosis of esophageal duplication was achieved by a contrast study of the esophagus with diatrizoate and computed tomographic scan. Surgical excision of the esophageal duplication was carried out. At the 1-year follow-up examination, the patient was doing well.

Cervical cystic swelling in an adolescent: unusual association of a cervical mature teratoma with vertebral anomalies and a history of gastric duplication cyst

A 14-year-old girl presented with a cervical cystic swelling in association with deformity of cervical vertebrae. As a child, she had been treated for gastric duplication. Pathologic examination of the resected cervical swelling revealed a mature teratoma. We discuss possible embryologic associations, which could explain the unusual combination of a mature teratoma with vertebral anomalies and gastric duplication.

Unusual noncommunicating isolated enteric duplication cyst in adults

Duplication cysts are rare gastrointestinal congenital abnormalities and can occur anywhere within the gastrointestinal tract. Duplication cysts are firmly attached to or share the wall of the alimentary tract and have a common blood supply with the adjacent segment of the bowel. Completely isolated duplication cysts are an extremely rare variety of gastrointestinal duplications with their own exclusive blood supply, and they do not communicate with the intestine. These cysts are usually diagnosed during early childhood, and very rarely detected in adults, mostly incidentally, due to a lack of symptoms. A 28-year-old male was admitted to our hospital with a chief complaint of lower abdominal pain and distention and a palpable mass for 1 month. Based upon computed tomography and sonographic findings, a small bowel duplication cyst was tentatively diagnosed. The cyst had no connection to the gastrointestinal tract. Herein we report the case of a noncommunicating isolated ileal duplication cyst in an adult. Resection of the cyst was performed safely without requiring bowel resection.

Appendix perforation in appendix duplication in a man: a case report

Introduction

Although appendix duplication is diagnosed as a rare congenital anomaly of the alimentary tract in childhood, a few adult cases have also been reported. Here we report a case of appendix duplication with perforated appendicitis co-existing with acute appendicitis in an adult patient.

Case presentation

A 33-year-old Caucasian man was admitted to our Emergency Department with right-sided lower-quadrant pain that we explored for presumed complicated appendicitis. On exploration, a perforated inflamed appendix was found coexisting with a second inflamed appendix which was subserosal and retrocecal. Appendectomies were performed, and the pathological examination confirmed the signs of acute inflammation in both appendixes.

Conclusion

Surgeons in emergency services should be aware of anatomical anomalies such as duplication and malposition of the appendix, even in patients with a history of previous appendectomy, because misdiagnosis of appendix duplication may lead to a poor clinical outcome and medicolegal issues.

Complications of congenital and developmental abnormalities of the gastrointestinal tract in adolescents and adults: evaluation with multimodality imaging

There is a wide variety of congenital anomalies that may affect the gastrointestinal tract. Most symptomatic congenital anomalies are found in newborns and infants. Such anomalies are relatively rare in adolescents and adults, and they may be difficult to identify because clinical symptoms often are nonspecific and insidious, causing them to be mistaken for other common abdominal conditions. Multimodality imaging is useful in evaluating congenital anomalies of the gastrointestinal tract in adults. The imaging features at radiography, fluoroscopy, ultrasonography, computed tomography, and magnetic resonance imaging may help identify congenital gastrointestinal anomalies such as congenital esophageal stenosis, gastric volvulus, duodenal web, annular pancreas, heterotopic pancreas, cecal volvulus, anomalies of the omphalomesenteric duct, Hirschsprung disease, and gastrointestinal duplication cyst. Familiarity with the imaging features of the various congenital anomalies of the gastrointestinal tract and their complications is important to establish the correct diagnosis and determine appropriate treatment, which is critical to avoid life-threatening complications.

Adenocarcinoma arising from colonic duplication cyst with metastasis to omentum: A case report

Gastrointestinal tract duplications are uncommon congenital abnormalities. Carcinoma arising from duplication cyst is extremely rare, not to mention metastasis to other organs. We present a case of adenocarcinoma arising from a colonic duplication cyst with invasion of the serosa and metastasis to the omentum in a 40-year-old man. Duplication cysts should be included in the differential diagnosis of cystic masses of the gastrointestinal tract. Because these lesions occur so infrequently, they are often not suspected until encountered intraoperatively. The specific findings and advantages of sonography are reviewed.