Different clinical presentations, diagnostic difficulties, and management of cecal duplication

A rare case of enteric duplication cyst in the cecum of a 7-year-old child: Case report

INTRODUCTION AND SIGNIFICANCE

Duplication of the digestive tract is a rare condition, especially when it is located in the cecum. In most cases, it is asymptomatic. The cystic pattern is the most common type of duplication of the digestive tract. The exact cause of this anomaly has not been determined yet.

CASE PRESENTATION

We present the case of a girl who was suffering from vague abdominal pain for a period of time without response to medical treatment. She was later diagnosed with a duplication cyst of the cecum, which was completely resected with a ileocolic anastomosis.

CLINICAL DISCUSSION

Surgery is generally the mainstay of treatment for duplication cysts of the digestive tract. Even in asymptomatic cases, surgical resection is preferred to avoid complications and the risk of malignant transformation.

CONCLUSION

It is always important to consider duplication of the digestive tract as a possible differential diagnosis for cysts in the cecum, and to avoid attempting to dissect the cyst away from the adjacent digestive tract.

A unique case of enteric duplication cyst in the cecum presenting as ileocolic intussusception in a 3-year-old child: Case report and review of the literature

INTRODUCTION AND SIGNIFICANCE

This is a rare case of enteric duplication cyst presenting as ileocolic intussusception in a child. The literature review found that there have been only a few other reported cases of this condition. In most cases, enteric duplication cysts are asymptomatic and are found incidentally. However, in some cases, they can cause symptoms such as abdominal pain, vomiting, constipation, and diarrhea. Intussusception is a rare complication of enteric duplication cysts.

CASE PRESENTATION

We present a case of a enteric duplication cyst in the cecum that was discovered through its association with a ileocolic intussusception that reached the anus. We diagnosed the ileocolic intussusception through an ultrasound, and during surgery, we discovered the presence of the enteric duplication cyst in the cecum. We resected it and performed a ileocolic anastomosis.

CLINICAL DISCUSSION

The treatment for enteric duplication cysts that are causing symptoms is surgery. During surgery, the cyst is removed and the intestine is repaired.

CONCLUSION

This case report highlights the importance of considering enteric duplication cyst as a possible cause of ileocolic intussusception in children.

Ileocecal duplication in children: a single-center experience of 115 cases

To evaluate the clinical features, surgical management, and prognosis of ileocecal duplication in children. A total of 115 patients diagnosed with ileocecal duplication at Beijing Children's Hospital between January 2010 and June 2021 were retrospectively reviewed. Ileocecal duplications were divided into ileal intraluminal (n = 41), ileal extraluminal (n = 24), ileocecal valve (n = 11), cecal intraluminal (n = 18), and cecal extraluminal (n = 3) types according to their locations. Median age at diagnosis was 9.5 (0.1-169.2) months. Intussusception was only observed preoperatively in patients with the ileal intraluminal (8/41), ileocecal valve (4/11), and cecal intraluminal (7/18) types (P = 0.004). Ileocecal resection and ileocolostomy and cyst excision without ileocecal resection were performed in 41 (35.7%) and 74 (64.3%) patients, respectively. The proportions of cyst excision without ileocecal resection performed in patients with different types were 78.0% (32/41), 91.7% (22/24), 27.3% (3/11), 27.8% (5/18), and 100.0% (3/3) (P < 0.001). Time of oral intake (P = 0.003) and hospital stay after surgery (P < 0.001) were significantly shorter in patients undergoing cyst excision without ileocecal resection. There were no significant differences in the complications, growth, and stool frequency (older than 4 years) between patients undergoing different surgical procedures. Regarding the stool consistency (older than 4 years), there was a lower proportion of dry stool in patients undergoing cyst excision (P = 0.008).

CONCLUSIONS

Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. At mid-term follow-up, the children's growth and defecation patterns do not seem to be affected by ileocecal resection.

WHAT IS KNOWN

• How to address ileocecal duplication has always been challenging in clinical management. • Children who have an ileocecal resection can develop some early postoperative complications.

WHAT IS NEW

• Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. • Children's growth and defecation patterns do not seem to be affected by ileocecal resection.

“Type C appendicular duplication with patent vitello-intestinal duct—an unforeseen association”—a case report

Background

Gastrointestinal duplications are uncommon occurring in 1 in 5000 live births. Small intestine is commonly involved, while appendicular duplications are extremely rare. Vitelline duct anomalies arise due to failure of involution of the omphalomesenteric duct. Their spectrum ranges from a simple umbilical sinus to completely patent omphalomesenteric fistulae. We report here a rare association of complete appendico-cecal duplication with patent vitello-intestinal duct (PVID).

Case presentation

A 14-year-old girl who presented with complaints of scant, foul smelling, and feculent discharge from umbilicus intermittently since birth was evaluated and diagnosed to have a patent vitello-intestinal duct. At laparotomy, a patent vitello-intestinal tract opening unusually at the ileo-cecal junction was noted. In addition, an appendico-cecal duplication cyst bearing an appendix on the mesenteric side and a 4-cm long orthotopic appendix on the native cecum was found with the duplex cecum sharing a common wall and blood supply. The terminal ileum with the duplication and patent vitello-intestinal duct were excised in toto, and an end-to-end ileo-ascending anastomosis was done. The child is well at 1 year follow-up.

Conclusion

A complete appendico-cecal (Type C) duplication with ectopically inserted patent vitello-intestinal duct is reported here as an unusual association, discussing its management and the probable disarray in the embryological development.