Gastrointestinal duplication cysts: what a radiologist needs to know

Endoscopic submucosal dissection in the treatment of adult cystic lymphangioma: A case report

BACKGROUND

Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract. In the early stage, most patients are asymptomatic; after the onset of symptoms, there is often no specificity regarding symptoms.

CASE SUMMARY

Here we report the endoscopic diagnosis and treatment of an adult patient with cystic lymphangioma of the ascending colon. One patient who came to our hospital with “dull pain in the left lower abdomen for 2 days” was initially misdiagnosed with a colon cyst according to endoscopy and then underwent endoscopic submucosal dissection. The final pathological results suggested cystic lymphangioma. One year later, no recurrence was found on re-examination via colonoscopy.

CONCLUSION

Cystic lymphangioma in the gastrointestinal tract rarely occurs in adults and is easily misdiagnosed or missed. Endoscopy, imaging, histology, and immunohistochemical staining are useful for diagnosis. Surgical resection is the preferred treatment.

Comparison of Endoscopic Ultrasound and CT Scan in the Diagnosis of Esophageal Duplication Cysts

BACKGROUND AND AIM

Esophageal duplication cysts (EDCs) are rare congenital malformations, often discovered incidentally during endoscopy or on computed tomography (CT) scans. The role of endoscopic ultrasound (EUS) and CT scan in the diagnosis of these lesions and indications for surgical treatment are underreported. The aim of this study was to investigate these topics in a cohort of patients.

MATERIALS AND METHODS

Between January 2001 and October 2020, 82 patients had a suspicion of esophageal duplication cyst on endoscopic ultrasound. Thirty four of these patients were referred for surgical enucleation of the lesion, but three patients were lost to follow-up. At the end, 31 patients, who underwent surgical treatment for their suspected EDC were included in this study. Clinical features, EUS findings, CT images, surgical treatment, and outcome were collected from hospital health records. CT images were re-evaluated by a chest radiologist. Type of surgery, surgical complications, and final histological diagnosis were reported.

RESULTS AND CONCLUSION

The patients referred for surgery were younger (p = 0.0001) and had larger lesions (> 2 cm; p = 0.005) than the patients who had non-operative follow-up. From thirty-one operated patients, eighteen (58%) had post-operative histological diagnosis of duplication cyst. On EUS the final histological diagnosis was correct in 58% (18/31) of all the operated cases and on CT scan 57% (17/30). CT scan misdiagnosed three of the EDCs but found two leiomyomas correctly. None of these patients developed malignancy. According to this study, neither EUS without fine-needle biopsy nor CT scan alone can differentiate EDCs from other mediastinal masses.

Late presentation of gastric duplication cyst in pediatric patient: Lessons learned

Gastrointestinal duplication is an infrequent congenital disorder characterized by the presence of a muscular layer covered by mucosa. Gastric duplication cysts account for approximately 2%-9% of all gastrointestinal duplication cysts. The typical clinical presentation often includes symptoms such as epigastric pain, vomiting, and the presence of a palpable abdominal mass. However, these symptoms can overlap with more common conditions. Diagnostic confirmation usually necessitates additional imaging studies, and surgical intervention is the recommended treatment approach. In this case report, we present the case of a 9-year-old girl who presented with chronic abdominal pain and vomiting. Following a comprehensive evaluation, including a CT scan and various diagnostic tests, a diagnosis of gastric duplication cyst was established. The patient subsequently underwent a laparotomy procedure, during which the cyst was completely excised. Follow-up visits indicated an uneventful recovery, with complete resolution of all symptoms. The aim of this work is to report on the clinico-radiological aspects of gastric duplication cysts and their surgical treatment.

[Developmental disorders of the gastrointestinal tract]

BACKGROUND

Developmental disorders of the gastrointestinal tract comprise a broad spectrum of congenital malformations of different etiologies and locations from the mouth to the anus.

METHODS

The authors present the most important malformations of the gastrointestinal tract on the basis of basic and current reviews.

RESULTS

Gastrointestinal developmental disorders occur both sporadically and in connection with malformation syndromes. Symptoms are highly variable and range from postnatal emergencies to asymptomatic abnormalities, which may be incidental radiological findings. Prenatal ultrasound examinations can often identify gastrointestinal developmental disorders at an early stage. Here, fetal magnetic resonance imaging can be a useful addition to the diagnostic process. In the first few days of life, simple X‑ray overview images, supplemented by images after the administration of contrast medium, are often sufficient.

CONCLUSION

Many patients with a malformation of the gastrointestinal tract require lifelong medical care, so that not only pediatric radiologists need specific knowledge about this group of diseases.

Surgery for long tubular intestinal duplication with massive hemorrhage: a case report and literature review

BACKGROUND

Long tubular duplication is a rare congenital intestinal disease, that can lead to emergency situations marked by massive hemorrhage. However, preoperative diagnosis and surgical treatment are challenging. This report presents preoperative images and details a surgical procedure for long tubular intestinal duplications with massive hemorrhage.

CASE PRESENTATION

A 3-year-old boy presented to the emergency department with melena. Despite undergoing a Tc-99m pertechnetate scintigraphy one year prior, which revealed nonspecific findings with enhancement of some parts of the intestine, enhanced abdominal CT revealed an edematous small intestine with luminal extravasation. The patient received a transfusion of red blood cells; however, his hemoglobin level did not improve. Arterial angiography and double-balloon endoscopy revealed no remarkable findings. Exploratory laparotomy revealed a long tubular duplication in half of the small intestine. Utilizing the Wrenn procedure, we successfully removed all duplicate mucosa. Pathological findings showed that almost all duplications contained gastric mucosa and revealed an ulcer with a ruptured arterial vessel. His symptoms were resolved, and the hemoglobin level stabilized. At 2 months postoperatively, no surgical complications were present.

CONCLUSIONS

Effective management of long tubular duplications with massive hemorrhage involves timely application of the Wrenn procedure. Recognition of specific imaging findings is crucial to prompt exploratory laparotomy, ensuring optimal outcomes and preventing delays in treatment.

Imaging congenital anomalies of the ileum in adults:a pictorial review

The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.

Magnetic resonance elastography of the liver: everything you need to know to get started

Magnetic resonance elastography (MRE) of the liver has emerged as the non-invasive standard for the evaluation of liver fibrosis in chronic liver diseases (CLDs). The utility of MRE in the evaluation of different CLD in both adults and children has been demonstrated in several studies, and MRE has been recommended by several clinical societies. Consequently, the clinical indications for evaluation of CLD with MRE have increased, and MRE is currently used as an add-on test during routine liver MRI studies or as a standalone test. To meet the increasing clinical demand, MRE is being installed in many academic and private practice imaging centers. There is a need for a comprehensive practical guide to help these practices to deliver high-quality liver MRE studies as well as troubleshoot the common issues with MRE to ensure smooth running of the service. This comprehensive clinical practice review summarizes the indications and provides an overview on why to use MRE, technical requirements, system set-up, patient preparation, acquiring the data, and interpretation.