1
|
Yuan Z, Wei H, Zhang Y, Cao B, He B, Yuan H. Gastric duplication cysts: literature review and a case report of rare multiple gastric duplication cysts treated by endoscopic submucosal dissection. Postgrad Med 2023; 135:775-783. [PMID: 37877305 DOI: 10.1080/00325481.2023.2274308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
Gastric duplication cysts (GDCs) are rare structural abnormalities, especially in adults. We first report a rare case of small multiple GDCs in a woman, which presents as a submucosal tumor (SMT) at the gastric antrum. In consideration of the patient's request for surgical treatment and minimally invasive resection, endoscopic submucosal dissection (ESD) was performed to remove the cyst. The case provides a reference for ESD surgery to remove small GDCs. So far, there is no consensus or practice guidelines for the diagnosis and management of GDCs. Herein we perform a comprehensive literature review and discussion on GDCs. GDCs are 'repetitive' cystic or tubular structures of gastric mucosa and muscularis mucosae, and share the muscularis propria and serous layer with the normal gastric wall. GDCs protruding into the stomach cavity can be diagnosed by endoscopic ultrasound (EUS), which has higher specificity and accuracy than CT and MRI. Some GDCs may cause complications, even cancerization. Therefore, we suggest that once found, the GDCs could be completely resected. For GDCs protruding into the stomach cavity, endoscopic surgery such as ESD can be adopted to remove the lesion. Endoscopic full-thickness resection (EFTR) may become an option for larger GDCs in the future. For extraluminal GDC, laparoscopic surgery is currently preferred. In this review, we summarized the structural and histopathological characteristics of GDCs and various treatment therapies, in order to provide experience and reference for the diagnosis and treatment of GDCs in the future.
Collapse
Affiliation(s)
- Ziying Yuan
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hongyun Wei
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yuejuan Zhang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bin Cao
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Baoguo He
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hao Yuan
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
2
|
Kim SM, Lee SH, Park GY, Kim SS, Lee CG, Jin SJ. Cecal duplication cyst in an infant presenting as shock: A case report. World J Clin Cases 2023; 11:6931-6937. [PMID: 37901014 PMCID: PMC10600866 DOI: 10.12998/wjcc.v11.i28.6931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Although intestinal obstruction is one of the most common surgical emergencies in an infant, it is difficult to diagnose neonatal enteric duplication cysts (EDC) preoperatively owing to their rarity as a cause of intestinal obstruction. We describe a case report of a neonatal EDC presenting intestinal obstruction and shock. CASE SUMMARY A 32-d-old male infant with a prenatal sonographic finding of bladder distension was admitted to our hospital for a severely distended abdomen, fever, and oliguria. The first diagnostic hypothesis was septic shock and intestinal obstruction. The patient's symptoms worsened; following an emergency surgical exploratory laparotomy and histopathological findings, the final diagnosis of cecal duplication cyst was confirmed. The patient's postoperative course was uneventful, and on the fifth postoperative day, oral feeding restarted. Twenty days later, the patient was discharged from the hospital. CONCLUSION Although EDC located in the cecum is exceptional, it should be considered when evaluating suspected intestinal obstruction and shock.
Collapse
Affiliation(s)
- Seung Mo Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Sun Hyang Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Ga Young Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soochunhyang University College of Medicine, Bucheon 14584, Gyeonggi-do, South Korea
| | - Cheol Gu Lee
- Department of General Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, GyeongGi-Do, South Korea
| | - Soo Ji Jin
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, GyeongGi-Do, South Korea
| |
Collapse
|
3
|
Altering Appearance of Fetal Enteric Duplication Cysts: The Gut Signature Sign and Other Indications for Prenatal Diagnosis. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-022-00332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
4
|
Lee W, Lee MY, Teo H. Ultrasound and alternative multimodality imaging of intra-abdominal and pelvic cystic masses in the newborn. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2021; 29:241-251. [PMID: 34777544 DOI: 10.1177/1742271x20984814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/07/2020] [Indexed: 01/09/2023]
Abstract
Introduction: Ultrasound is used commonly to detect and diagnose intra-abdominal and pelvic cystic masses in the newborn as it is easily available, relatively low cost, and non-invasive. Discussion: The diagnosis can be made or narrowed down by determining the location, size, sonographic features, organ involvement, and internal vascularity. The differential diagnoses include hydronephrosis, multicystic dysplastic kidney, adrenal haemorrhage, cystic teratomas, ovarian cysts, enteric cysts, meconium cysts, and liver haemangiomas. With the appropriate radiological knowledge, the ultrasound practitioner can help obtain an accurate diagnosis. Conclusion: This pictorial essay will familiarise the reader with the different common causes of intra-abdominal and pelvic masses detected on ultrasound through a wide range of conditions. The role of ultrasound in the evaluation of these conditions will be discussed and alternative imaging correlates will be offered.
Collapse
Affiliation(s)
- Weiyong Lee
- Department of Diagnostic Radiology, Singapore General Hospital, Bukit Merah, Singapore
| | | | - Harvey Teo
- KK Women's and Children's Hospital Singapore, Kampong Java, Singapore
| |
Collapse
|
5
|
Inarejos Clemente EJ, Navarro OM, Navallas Irujo M, Ladera E, Colombo C, Suñol M, Sousa P, Barber Martínez de la Torre I. Omphalomesenteric Duct Anomalies in Children: A Multimodality Overview. Radiographics 2021; 41:2090-2110. [PMID: 34723700 DOI: 10.1148/rg.2021210048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The omphalomesenteric duct is an embryologic structure that connects the yolk sac with the primitive midgut of the developing fetus. Omphalomesenteric duct anomalies include a group of entities that result from failed resorption of the omphalomesenteric duct. These anomalies include Meckel diverticulum, omphalomesenteric fistula, fibrous bands, cysts, and umbilical polyps. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic. Symptoms develop when Meckel diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. Hemorrhage is the most common complication of Meckel diverticulum, and technetium 99m-pertechnetate scintigraphy is the imaging modality of choice for detecting acute bleeding. US and CT are commonly used for the evaluation of patients with other complications such as obstruction and inflammation. Nevertheless, the diagnosis of these complications can be challenging, as their clinical manifestations are usually nonspecific and can masquerade as other acute intraabdominal entities such as appendicitis, inflammatory bowel disease, or other causes of bowel obstruction. There are other umbilical disorders, such as urachal remnants and umbilical granuloma, that may present with symptoms and imaging findings similar to those of omphalomesenteric duct anomalies. An accurate preoperative diagnosis of omphalomesenteric duct anomaly is crucial for appropriate management and a better outcome, particularly when these anomalies manifest as a life-threatening condition. The authors review the anatomy, clinical features, and complications of omphalomesenteric duct anomalies in children, describing the relevant differential diagnoses and associated imaging findings seen with different imaging modalities. ©RSNA, 2021.
Collapse
Affiliation(s)
- Emilio J Inarejos Clemente
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - María Navallas Irujo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Enrique Ladera
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Cecilia Colombo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Mariona Suñol
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Paulino Sousa
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Ignasi Barber Martínez de la Torre
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| |
Collapse
|
6
|
Bulotta AL, Stern MV, Moneghini D, Parolini F, Bondioni MP, Missale G, Boroni G, Alberti D. Endoscopic treatment of periampullary duodenal duplication cysts in children: Four case reports and review of the literature. World J Gastrointest Endosc 2021; 13:529-542. [PMID: 34733413 PMCID: PMC8546566 DOI: 10.4253/wjge.v13.i10.529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/30/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duodenal duplications are rare congenital anomalies of the gastrointestinal tract. As the periampullary variant is much rarer, literature is scant and only few authors have reported their experience in diagnosis and treatment, particularly with operative endoscopy.
CASE SUMARY To report our experience with the endoscopic treatment in a series of children with periampullary duodenal duplication cysts, focusing on the importance of obtaining an accurate preoperative anatomic assessment of the malformations. The pediatric periampullary duodenal duplication cyst literature is reviewed. We conducted a systematic review according to the PRISMA guidelines. The PubMed database was searched for original studies on “duodenal duplication”, “periampullary duplication” or “endoscopic management” published since 1990, involving patients younger than 18 years of age. Eligible study designs were case report, case series and reviews. We analyzed the data and reported the results in table and text. Fifteen eligible articles met the inclusion criteria with 16 patients, and analysis was extended to our additional 4 cases. Median age at diagnosis was 13.5 years. Endoscopic treatment was performed in 10 (50%) patients, with only 2 registered complications.
CONCLUSION Periampullary duodenal duplication cysts in pediatric patients are very rare. Our experience suggests that an accurate preoperative assessment is critical. In the presence of sludge or stones inside the duplication, endoscopic retrograde cholangio-pancreatography is mandatory to demonstrate a communication with the biliary tree. Endoscopic treatment resulted in a safe, minimally invasive and effective treatment. In periampullary duodenal duplication cyst endoscopically treated children, long-term follow-up is still necessary considering the potential malignant transformation at the duplication site.
Collapse
Affiliation(s)
- Anna Lavinia Bulotta
- Department of Pediatric Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| | - Maria Vittoria Stern
- Department of Pediatric Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| | - Dario Moneghini
- Department of Digestive Endoscopy, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| | - Filippo Parolini
- Department of Pediatric Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| | - Maria Pia Bondioni
- Department of Pediatric Radiology, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| | - Guido Missale
- Department of Digestive Endoscopy, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| | - Giovanni Boroni
- Department of Pediatric Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| | - Daniele Alberti
- Department of Pediatric Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia 25123, Italy
| |
Collapse
|
7
|
Boulos AK, Long RA. Fussiness and New-Onset Diarrhea for 2 Weeks in a 9-week-old Girl. Pediatr Rev 2021; 42:562-565. [PMID: 34599056 DOI: 10.1542/pir.2020-002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Andrew K Boulos
- University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX
| | - Rachel A Long
- University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX
| |
Collapse
|
8
|
Phipps WB, Rich AF, Rossanese M. Asymptomatic Enteric Duplication Cyst in a Geriatric Cat: Case Report and Review of the Literature. J Am Anim Hosp Assoc 2021; 57:133-138. [PMID: 33770172 DOI: 10.5326/jaaha-ms-7057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 11/11/2022]
Abstract
An 11 yr old female neutered domestic shorthair presented for an 8 mo history of an asymptomatic abdominal mass. Computed tomography described an irregular, cystic structure closely associated with the duodenum, and focal ultrasonography confirmed the mass shared outer layers with the intestinal wall. Coeliotomy revealed the mass was originating from, and firmly adhered to, the antimesenteric border of the duodenum but was not communicating with the intestinal lumen. En bloc mass resection with omentalization was performed without small intestinal resection. Histopathology confirmed an enteric duplication cyst. The cat made a full recovery and remained asymptomatic postoperatively with no evidence of recurrence. A review of the literature confirms the duodenum to be the most common location of enteric duplication cysts in felines and that subtotal excision is curative in most cases. This differential should be considered in cases of cystic gastrointestinal structures in juvenile and adult felines, with or without associated clinical signs. In cases of luminal involvement or malignant transformation, intestinal resection and anastomosis is more appropriate. This report describes the presentation, investigations, and treatment of an asymptomatic duodenal duplication cyst in an adult feline and summarizes and compares current knowledge of the condition between veterinary and human literature.
Collapse
|
9
|
Yacoub JH, Clark JA, Paal EE, Manning MA. Approach to Cystic Lesions in the Abdomen and Pelvis, with Radiologic-Pathologic Correlation. Radiographics 2021; 41:1368-1386. [PMID: 34469214 DOI: 10.1148/rg.2021200207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cystic lesions found in and around the peritoneal cavity can often be challenging to diagnose owing to significant overlap in imaging appearance between the different entities. When the cystic lesion can be recognized to arise from one of the solid abdominal organs, the differential considerations can be more straightforward; however, many cystic lesions, particularly when large, cannot be clearly associated with one of the solid organs. Cystic lesions arising from the mesentery and peritoneum are less commonly encountered and can be caused by relatively rare entities or by a variant appearance of less-rare entities. The authors provide an overview of the classification of cystic and cystic-appearing lesions and the basic imaging principles in evaluating them, followed by a summary of the clinical, radiologic, and pathologic features of various cystic and cystic-appearing lesions found in and around the peritoneal cavity, organized by site of origin. Emphasis is given to lesions arising from the mesentery, peritoneum, or gastrointestinal tract. Cystic lesions arising from the liver, spleen, gallbladder, pancreas, urachus, adnexa, or soft tissue are briefly discussed and illustrated with cases to demonstrate the overlap in imaging appearance with mesenteric and peritoneal cystic lesions. When approaching a cystic lesion, the key imaging features to assess include cyst content, locularity, wall thickness, and presence of internal septa, solid components, calcifications, or any associated enhancement. While definitive diagnosis is not always possible with imaging, careful assessment of the imaging appearance, location, and relationship to adjacent structures can help narrow the differential diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
Collapse
Affiliation(s)
- Joseph H Yacoub
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Jennifer A Clark
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Edina E Paal
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Maria A Manning
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| |
Collapse
|
10
|
D'Agostino V, Castaldo A, Catelli A, Pesce I, Genovese S, Coppola L, Monaci A, Esposito C, Amitrano M. An ileal duplication cyst case report: From diagnosis to treatment. Radiol Case Rep 2021; 16:1597-1602. [PMID: 33995750 PMCID: PMC8102431 DOI: 10.1016/j.radcr.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/30/2022] Open
Abstract
Enteric duplication cysts (EDCs) are rare congenital malformations of the children and can develop everywhere along the gastrointestinal (GI) tract, being the ileum the most frequent localization. We herein present an unusual case of duplication cyst of ileal origin who show a tubular morphology and doesn't communicate with GI lumen. A 2-month-old boy was admitted to our hospital for investigation of an anechoic formation of the lower right abdomen for the surgical planning. The patient was asymptomatic. Ultrasound (US) and magnetic resonance imaging (MRI) showed features of a cystic lesion. Laparoscopic surgery was performed and the cyst excised. Macroscopic examination and histologic findings confirmed the diagnosis of a enteric duplication cyst arising from the ileum. In a patient with an abdominal cystic mass, although asymptomatic, it's worth assessing the nature of the lesion and planning a surgery in order to avoid future complications. A correct use of diagnostic it's fundamental to identify the etiology and the characteristics of a cystic mass.
Collapse
Affiliation(s)
- Valerio D'Agostino
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Anna Castaldo
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Antonio Catelli
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Ilaria Pesce
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Stefano Genovese
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Luigi Coppola
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Alessandro Monaci
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Ciro Esposito
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| | - Michele Amitrano
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples, Italy
| |
Collapse
|
11
|
Muthee BW, Bray HJ. Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts. Ultrasonography 2021; 41:53-73. [PMID: 34344138 PMCID: PMC8696132 DOI: 10.14366/usg.21070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
Collapse
Affiliation(s)
- Bernadette Wambui Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Bray
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
12
|
Pai NG, Prabhu S, Prabhakar P, Kumar V. Duplication cyst with midgut volvulus in a neonate: an unusual presentation. BMJ Case Rep 2020; 13:13/8/e235526. [PMID: 32847882 DOI: 10.1136/bcr-2020-235526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Incomplete intestinal fixation or malrotation of gut with midgut volvulus is one of the important causes of bilious vomiting in neonates. The incidence of malrotation of gut in population is 4% and that of duplication cyst is 1:4500. Patients with malrotation are prone to develop midgut volvulus due to their narrow mesenteric base demanding urgent surgical intervention. Common associated anomalies are intrinsic duodenal obstruction, internal hernias, caecal volvulus, anorectal malformations and Hirschsprung's disease. The present case refers to a 4-day-old neonate who presented with malrotation of gut with reverse volvulus and an associated gastrointestinal duplication cyst, which is a rare association with only few reported case reports. After imaging with ultrasound and contrast radiograph, the baby underwent prompt surgical intervention in the form of Ladd's procedure with resection and anastomosis of jejunal duplication cyst.
Collapse
Affiliation(s)
- Nitin G Pai
- Department of Paediatric Surgery, Kasturba Medical College, Manipal, India
| | - Santosh Prabhu
- Department of Paediatric Surgery, Kasturba Medical College, Manipal, India
| | | | - Vijay Kumar
- Department of Paediatric Surgery, Kasturba Medical College, Manipal, India
| |
Collapse
|
13
|
Dynamic Compression-A New and Practical Technique for the Sonographic Diagnosis of Enteric Duplication. Ultrasound Q 2020; 35:385-391. [PMID: 30601442 DOI: 10.1097/ruq.0000000000000407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aims to examine the utility of dynamic compression and other sonographic signs in diagnosing enteric duplication. METHODS This study reviewed real-time sonographic findings from ultrasound examinations performed by the author between April 2015 and March 2017, including 4 consecutive cases of enteric duplication and 7 cases of other abdominal cysts (control group). The ability of dynamic compression to separate the lesion from the adjacent intestine was analyzed, as were other sonographic signs, including the 5-layer sign, peristalsis, and the split-wall sign. RESULTS The 5-layer sign and peristalsis were seen in only 1 of 4 cases of enteric duplication. The split-wall sign was positive in all 4 cases of enteric duplication. In a case of gastric duplication, the split-wall sign was not detected during the first examination. One case showed an atypical white split wall, and 3 cases showed a pseudo-split wall; however, this pseudo-split wall was differentiated from the true split-wall sign using dynamic compression. The dynamic compression technique correctly differentiated enteric duplication from other abdominal cysts in all but 2 cases (82%). CONCLUSIONS The 5-layer sign and peristalsis were not sensitive for enteric duplication. The split-wall sign may have the highest sensitivity and specificity for enteric duplication, but finding this sign is technically difficult and interpretation is complicated by atypical variations. Dynamic compression differentiated enteric duplication from other abdominal cysts with 82% accuracy, and this technique was simple to perform and easier to interpret than the split-wall sign.
Collapse
|
14
|
Al-Shaibi MA, Raniga SB, Asghar ANM, Al Tubi IS. Caecal duplication cyst leading to intussusception in an adult. BMJ Case Rep 2019; 12:e230567. [PMID: 31511265 PMCID: PMC6738667 DOI: 10.1136/bcr-2019-230567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 12/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Maha A Al-Shaibi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sameer B Raniga
- Radiology Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Abdul N M Asghar
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ikhtiyar S Al Tubi
- Department of General Surgery, Oman Medical Speciality Board, Al-Athaiba, Oman
| |
Collapse
|
15
|
Danys D, Martinaitytė R, Zacharic J, Poskus E, Zurauskas E, Poskus T, Strupas K. Enterogenous cyst of the small bowel mesentery: a case report and review of the literature. Acta Chir Belg 2019; 119:52-55. [PMID: 29221426 DOI: 10.1080/00015458.2017.1411551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Enterogenous cysts are a very rare congenital abnormality that can be found anywhere within the gastrointestinal tract, most commonly in the small intestine. The incidence is approximately one in 4500-10,000 live births. Diagnosis can be suggested by ultrasound (US), computed tomography (CT) scans or magnetic resonance imaging (MRI) findings, although histological examination confirms the definitive diagnosis. PATIENTS We present a case of enterogenous cyst in an adult female who underwent a resection of the tumour. RESULTS After two years of observation, there is no evidence of tumour recurrence.
Collapse
Affiliation(s)
- Donatas Danys
- Center of Abdominal Surgery, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | | | | | - Eligijus Poskus
- Center of Abdominal Surgery, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | | | - Tomas Poskus
- Center of Abdominal Surgery, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Kęstutis Strupas
- Center of Abdominal Surgery, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| |
Collapse
|
16
|
Sangüesa Nebot C, Llorens Salvador R, Carazo Palacios E, Picó Aliaga S, Ibañez Pradas V. Enteric duplication cysts in children: varied presentations, varied imaging findings. Insights Imaging 2018; 9:1097-1106. [PMID: 30311079 PMCID: PMC6269332 DOI: 10.1007/s13244-018-0660-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Cinta Sangüesa Nebot
- Radiology Department, Paediatric Imaging Section, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Roberto Llorens Salvador
- Radiology Department, Paediatric Imaging Section, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Elena Carazo Palacios
- Paediatric Surgery Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Sara Picó Aliaga
- Radiology Department, Paediatric Imaging Section, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Vicente Ibañez Pradas
- Paediatric Surgery Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
17
|
Nakashima S, Yamada T, Sato G, Sakai T, Chinen Y, Itakura H, Kato R, Ueda M, Tsuda Y, Ohta K, Matsuyama J, Ikenaga M. A case of completely isolated advanced enteric duplication cyst cancer performed partial pancreatectomy. Int J Surg Case Rep 2018; 54:83-86. [PMID: 30553095 PMCID: PMC6297057 DOI: 10.1016/j.ijscr.2018.11.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/22/2018] [Accepted: 11/25/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Enteric duplication cysts are rare and, in addition, isolated enteric duplication cysts are lower morbidity prevalence rate. These cysts lack a connection to the gastrointestinal tract or the adjacent mesenteric vasculature and have only been reported in 10 case reports. In these reports, only two reports were cases with malignant transformation. Our case was a report for the advanced cancer of the isolated enteric duplication cyst. CASE PRESENTATION The patient was a 43 year-old woman with slightly abdominal pain and mass formation. The abdominal contrast-enhanced computed tomography showed 130 × 100 × 90 mm huge cystic mass existed in right upper peritoneal cavity. The cystic mass had thickened wall and many enhanced nodules. As these imaging findings suggested a tumor originated from pancreas and the preoperative diagnose was suspect of mucinous cystic neoplasm. In operative findings, the tumor originated from pancreatic head and did not attach to gastrointestinal tract. Final pathology indicated the cyst was an isolated advanced enteric duplication cyst cancer and not originated from pancreas. CONCLUSION We experienced an extremely rare case of completely isolated advanced enteric duplication cyst cancer. Unique to this case, the preoperative diagnosis was suspect of mucinous cystic neoplasm arising from pancreas head and partial pancreatectomy was performed. However, in the pathological findings, this cyst diagnosed advanced enteric duplication cyst cancer.
Collapse
Affiliation(s)
- Shinsuke Nakashima
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Terumasa Yamada
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan.
| | - Go Sato
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Takaaki Sakai
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Yoshinao Chinen
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Hiroaki Itakura
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Ryo Kato
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Masami Ueda
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Yujiro Tsuda
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Katsuya Ohta
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Jin Matsuyama
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Masakazu Ikenaga
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| |
Collapse
|
18
|
Xiao-Ming A, Jin-Jing L, Li-Chen H, Lu-Lu H, Xiong Y, Hong-Hai Z, Nian-Yin Y. A huge completely isolated duplication cyst complicated by torsion and lined by 3 different mucosal epithelial components in an adult: A case report. Medicine (Baltimore) 2018; 97:e13005. [PMID: 30383655 PMCID: PMC6221613 DOI: 10.1097/md.0000000000013005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Intestinal or enteric duplication (ED) does exit as a rare congenital malformation of the gastrointestinal system clinically. It is a separate entity, but can be communicated with the gastrointestinal tract. It is characterized by a well-developed muscular wall and lumen endowed with ectopic mucosa, simulating a portion of normal bowel. A completely isolated duplication cyst (CIDC) refers to an extremely uncommon variant of ED, which is secluded from the alimentary tract and possesses its own exclusive blood supply. Surgical procedure is the treatment of choice, because most often, a definitive diagnosis can only be confirmed intraoperatively. PATIENT CONCERNS A 20-year-old male patient presented with a 10-day history of intermittent episodes of abdominal pain. The pain evolved from dull into progressive and intolerable, accompanied by vomiting, nausea, and abdominal distention. DIAGNOSES Closed-loop small-bowel obstruction with volvulus. INTERVENTIONS The patient underwent an emergency exploratory laparotomy. OUTCOMES A huge CIDC was observed upon operation, which was affixed to the mesentery with only a narrow base, just like a pedicle; 720° counterclockwise twisting around its base was definitely noted, provoking the compromised blood supply. Complete excision of the cyst was performed along its base safely without violating the intestinal tract. Furthermore, the ectopic mucosa of the cyst exhibited 3 different epithelial lining components histopathologically. LESSONS Clinicians should be aware of the possibility of the existence of a duplication and raise a high index of suspicion in case of equivocal diagnosis, particularly in adult population. A low threshold for surgical management should be recommended in order to prevent lethal outcomes.
Collapse
|
19
|
Shaaban AM, Rezvani M, Olpin JD, Kennedy AM, Gaballah AH, Foster BR, Menias CO, Elsayes KM. Nongynecologic Findings Seen at Pelvic US. Radiographics 2017; 37:2045-2062. [PMID: 29131764 DOI: 10.1148/rg.2017170083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Ultrasonography (US) is frequently the first imaging modality used to examine women with symptoms involving the pelvis. It is widely available and involves no exposure to ionizing radiation. Images can be acquired with a transabdominal, endovaginal, or translabial approach, and the use of video clips and three-dimensional reconstructions can be helpful. US is excellent for assessment of the uterus, ovaries, and adnexa. Occasionally, nongynecologic pelvic diseases arising from the gastrointestinal, genitourinary, and musculoskeletal systems and the pelvic peritoneal and extraperitoneal spaces may be detected and can be a source of diagnostic dilemma. US can be helpful not only in the detection but also occasionally in the characterization of such entities. Computed tomography and magnetic resonance imaging are useful in complicated cases. In this article, the normal US appearance of the bowel and US signs of bowel disease and specific entities, including appendicitis, diverticular disease, bowel obstruction, appendiceal mucocele, and intestinal tumors, are reviewed. The lower urinary tract is included in the field of view in every pelvic US examination; commonly encountered entities related to the urinary bladder, distal ureter, and urethra are illustrated. In addition to arising in the gastrointestinal and genitourinary tracts, pathologic conditions in the pelvis can arise in the peritoneal or extraperitoneal space. Although conditions of the pelvic peritoneal and extraperitoneal spaces are rare, it is important to recognize these entities and distinguish them from the more common gynecologic diseases. Owing to the implications for diagnosis and management, radiologists and other physicians who perform pelvic US should be aware of the spectrum of nongynecologic pathologic entities that can be detected. ©RSNA, 2017.
Collapse
Affiliation(s)
- Akram M Shaaban
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Maryam Rezvani
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Jeffrey D Olpin
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Anne M Kennedy
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Ayman H Gaballah
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Bryan R Foster
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Christine O Menias
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| |
Collapse
|
20
|
Ultrasound assessment of the bowel: inflammatory bowel disease and conditions beyond. Pediatr Radiol 2017; 47:1082-1090. [PMID: 28779191 DOI: 10.1007/s00247-017-3877-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
Ultrasound (US) is a versatile imaging study for the evaluation of the bowel in children. US imaging of the bowel can be used as the initial examination or in follow-up for many common pediatric diseases. In this article, we highlight our bowel US technique and describe how US can depict the features of a select group of bowel pathologies relevant to pediatric practice.
Collapse
|
21
|
A Wandering Abdominal Mass in a Neonate: An Enteric Duplication Cyst Mimicking an Ovarian Cyst. Case Rep Pediatr 2017; 2017:9209126. [PMID: 28348910 PMCID: PMC5352883 DOI: 10.1155/2017/9209126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 11/17/2022] Open
Abstract
Enteric duplication cysts are rare congenital anomalies that are prenatally diagnosed through antenatal ultrasonography (US). In female patients, however, attention must be paid since these formations might be confused with ovarian cysts. Herein, we present a case of a low birth weight female infant with an enteric duplication cyst. A cystic lesion was detected in the right abdomen of the fetus on antenatal US and magnetic resonance imaging (MRI). Serial US and MRI examinations performed after birth showed a single cyst that wandered from side to side in the abdomen; the initial diagnosis was thought to be an ovarian cyst. During laparotomy, however, it was found to be an enteric duplication cyst with volvulus. To our knowledge, there has been no report of an enteric duplication cyst presenting as a wandering abdominal mass. Our experience indicates that early intervention is necessary for patients who have a wandering abdominal mass to avoid complications and urgent surgery, whether it is an ovarian cyst or an enteric duplication cyst.
Collapse
|
22
|
Agut A, Carrillo JD, Martínez M, Murciano J, Belda E, Bernabé A, Soler M. IMAGING DIAGNOSIS-RADIOGRAPHIC, ULTRASONOGRAPHIC, AND COMPUTED TOMOGRAPHIC CHARACTERISTICS OF A DUODENAL DUPLICATION CYST IN A YOUNG CAT. Vet Radiol Ultrasound 2017; 59:E22-E27. [DOI: 10.1111/vru.12469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 01/07/2023] Open
Affiliation(s)
- Amalia Agut
- Department of Animal Veterinary Medicine and Surgery; University of Murcia; Spain
- Veterinary Teaching Hospital; University of Murcia; Spain
| | | | | | - Jose Murciano
- Department of Animal Veterinary Medicine and Surgery; University of Murcia; Spain
- Veterinary Teaching Hospital; University of Murcia; Spain
| | - Eliseo Belda
- Department of Animal Veterinary Medicine and Surgery; University of Murcia; Spain
- Veterinary Teaching Hospital; University of Murcia; Spain
| | - Antonio Bernabé
- Veterinary Teaching Hospital; University of Murcia; Spain
- Department of Anatomy and Pathological Anatomy; University of Murcia; Spain
| | - Marta Soler
- Department of Animal Veterinary Medicine and Surgery; University of Murcia; Spain
- Veterinary Teaching Hospital; University of Murcia; Spain
| |
Collapse
|
23
|
Gupta A, Chakaravarthi K, Pattnaik B, Kaman L. Duplication cyst of ileum presenting as acute intestinal obstruction in an adult. BMJ Case Rep 2016; 2016:bcr-2016-214775. [PMID: 27758850 DOI: 10.1136/bcr-2016-214775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Duplication cysts occur because of congenital aberration during gut development. They are commonly diagnosed during infancy and rarely during adulthood. We present an adult male who presented to surgical emergency with acute intestinal obstruction. Intraoperatively, this patient was found to have a non-communicating duplication cyst of ileum causing proximal obstruction. The involved segment of the small bowel was resected and a divided loop ileostomy was created.
Collapse
Affiliation(s)
| | | | | | - Lileswar Kaman
- Department of General Surgery, PGIMER, Chandigarh, Chandigarh, India
| |
Collapse
|
24
|
Ultrasound of the duodenum in children. Pediatr Radiol 2016; 46:1324-31. [PMID: 27003134 DOI: 10.1007/s00247-016-3564-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/06/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
Ultrasound is well suited for examining the pediatric duodenum, given the small size of the patients, the lack of ionizing radiation and high-resolution imaging potential. Technical considerations, normal anatomy, congenital and acquired pathology of the duodenum, and the advantages and limitations of US are discussed and illustrated in this review.
Collapse
|
25
|
Gale HI, Gee MS, Westra SJ, Nimkin K. Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol 2016; 8:656-667. [PMID: 27551336 PMCID: PMC4965350 DOI: 10.4329/wjr.v8.i7.656] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.
Collapse
|
26
|
Kim HS, Yoo SY, Cha MJ, Kim JH, Jeon TY, Kim WK. Diagnosis of neonatal ovarian torsion: Emphasis on prenatal and postnatal sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:290-297. [PMID: 27154434 DOI: 10.1002/jcu.22327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/28/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Our aim was to retrospectively review the imaging findings of patients with neonatal ovarian torsion, emphasizing prenatal and postnatal sonographic findings. METHODS Eleven patients who had had neonatal ovarian torsion diagnosed surgically (n = 9) or clinicoradiologically (n = 2) were enrolled. Prenatal and postnatal sonographic features, including sequential postnatal change, were reviewed. Clinical and pathologic features were also investigated. RESULTS All patients except one had a fetal ovarian cyst (mean, 5.3 cm) detected on third-trimester sonography, either simple (n = 6) or complex (n = 4). In all 11 patients, initial postnatal sonography had revealed a complex cyst (mean, 4.7 cm) with intracystic clot or debris, the double-wall sign, a fluid-fluid level, and multiple septation. None of the patients had had symptoms or signs related to the ovarian torsion. Follow-up sonography in seven patients had revealed increased echogenicity of the cyst wall with frequent calcification and a decrease in size of the cyst. In two patients, the interval of the change in cyst position was noted, and autoamputation of the torsed ovary had been surgically confirmed. Serous cystadenoma had been identified in one patient. CONCLUSIONS Neonatal ovarian torsion most commonly manifests as an asymptomatic complex cyst on sonography due to torsion of a fetal ovarian cyst. Serial monitoring of a fetal ovarian cyst for its resolution or changes in its appearance is mandatory for making an early diagnosis of torsion. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:290-297, 2016.
Collapse
Affiliation(s)
- Hyun Su Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Min Jae Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Wee Kyoung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
- Department of Radiology, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-712, Korea
| |
Collapse
|
27
|
Udiya AK, Shetty GS, Chauhan U, Singhal S, Prabhu SM. Multiple Isolated Enteric Duplication Cysts in an Infant - A Diagnostic Dilemma. J Clin Diagn Res 2016; 10:TD15-6. [PMID: 26894149 DOI: 10.7860/jcdr/2016/15129.7129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 10/11/2015] [Indexed: 12/24/2022]
Abstract
Completely isolated enteric duplication cysts are a rare variety of enteric duplication cysts having an independent blood supply with no communication with any part of the adjacent bowel segment. We report a case showing two completely isolated enteric duplication cysts originating in the greater omentum and transverse mesocolon in an infant. Multiple isolated enteric duplication cysts involving non-contiguous bowel segments have not been previously reported in the literature. In addition the transverse mesocolon duplication cyst was infected showing septations and loss of double wall sign resulting in difficulty in imaging diagnosis. Both the cysts were excised and confirmed on histopathology.
Collapse
Affiliation(s)
- Alok Kumar Udiya
- Senior Resident, Department of Radiodiagnosis, Institute of Liver and Bilary Sciences , New Delhi, India
| | - Gurucharan S Shetty
- Senior Resident, Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi, India
| | - Udit Chauhan
- Senior Resident, Department of Radiodiagnosis, GB Pant Hospital , New Delhi, India
| | - Shweta Singhal
- Senior Resident, Department of Radiodiagnosis, Lady Hardinge Medical College and assoc. SSK and KSC hospitals , Connaught Place, New Delhi, India
| | | |
Collapse
|
28
|
Presentation and Surgical Management of Duodenal Duplication in Adults. Case Rep Surg 2015; 2015:659150. [PMID: 26844004 PMCID: PMC4710945 DOI: 10.1155/2015/659150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/11/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022] Open
Abstract
Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult as symptoms are largely nonspecific. Clinical presentations include pancreatitis, biliary obstruction, gastrointestinal bleeding from ectopic gastric mucosa, and malignancy. A case of duodenal duplication in a 59-year-old female is presented, and her treatment course is reviewed with description of combined surgical and endoscopic approach to repair, along with a review of historic and current recommendations for management. Traditionally, gastrointestinal duplications have been treated with surgical resection; however, for duodenal duplications, the anatomic proximity to the biliopancreatic ampulla makes surgical management challenging. Recently, advances in endoscopy have improved the clinical success of cystic intraluminal duodenal duplications. Despite these advances, surgical resection is still recommended for extraluminal tubular duplications although combined techniques may be necessary for long tubular duplications. For duodenal duplications, a combined approach of partial excision combined with mucosal stripping may offer advantage.
Collapse
|
29
|
The sonographic multilaminar appearance is not enough for the diagnosis of enteric duplication cyst in children. AJR Am J Roentgenol 2015; 204:W222-3. [PMID: 25615791 DOI: 10.2214/ajr.14.13560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
30
|
Trinh TW, Kennedy AM. Fetal Ovarian Cysts: Review of Imaging Spectrum, Differential Diagnosis, Management, and Outcome. Radiographics 2015; 35:621-35. [DOI: 10.1148/rg.352140073] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
31
|
Postnatal sonographic spectrum of prenatally detected abdominal and pelvic cysts. AJR Am J Roentgenol 2015; 203:W684-96. [PMID: 25415735 DOI: 10.2214/ajr.13.12371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to illustrate the sonographic findings of a spectrum of neonatal abdominal and pelvic cystic lesions. CONCLUSION Neonatal abdominal and pelvic cystic lesions can arise from many organs, and they have a broad differential diagnosis. Distinctive sonographic findings may be present and can help establish the correct cause and guide proper management.
Collapse
|
32
|
Enteric duplication cyst containing squamous and respiratory epithelium: an interesting case of a typically pediatric entity presenting in an adult patient. Case Rep Gastrointest Med 2014; 2014:790326. [PMID: 25221678 PMCID: PMC4158108 DOI: 10.1155/2014/790326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/13/2014] [Indexed: 01/26/2023] Open
Abstract
Enteric duplication cysts are rare congenital malformations that can occur at any point along the digestive tract, most commonly the small bowel. They are characterized by the presence of an outer layer of smooth muscle and an inner lining of mucosa that may resemble any portion of the digestive tract. Less commonly, cases have been reported that also contain mucosal components of nonintestinal origin. This entity is typically diagnosed in young children, but occasionally presents in adolescence and young adulthood. We present a rare case of a 21-year-old male who presented with nonspecific symptoms of abdominal discomfort and weight loss and was later found to have a 9 cm nonenhancing mass in the distal ileum on CT imaging. Laparoscopic dissection of the mass revealed a cystic lesion lined mainly by pseudostratified ciliated columnar respiratory-type epithelium, with patchy areas of squamous epithelium as well as villous columnar epithelium resembling small bowel. The unique histology and advanced patient age make this case a unique presentation of what is already a rare pathological entity.
Collapse
|
33
|
Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol 2014; 202:946-59. [PMID: 24758646 DOI: 10.2214/ajr.13.11661] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the indications and techniques for bowel ultrasound for inflammatory bowel disease and other common and uncommon entities and describe and illustrate their imaging appearances, including endoscopic or surgical correlation. CONCLUSION Ultrasound is a useful tool for the evaluation of inflammatory bowel disease and many other bowel diseases. Radiologists must become familiar with the full potential of ultrasound in the evaluation of the bowel in children because the need for alternative radiation-free imaging techniques continues to grow.
Collapse
|
34
|
Pandey S, Srivastava A, Lal R, Yachha SK, Poddar U. Enteric duplication cysts in children: a target in algorithm for evaluation of lower gastrointestinal bleeding. Indian J Gastroenterol 2014; 33:285-8. [PMID: 24715677 DOI: 10.1007/s12664-014-0445-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/22/2014] [Indexed: 02/04/2023]
Abstract
Lower gastrointestinal bleeding (LGIB) in infants and children is a difficult diagnostic problem largely due to limitations of small-bowel evaluation. Duplication cysts are rare congenital malformations with variable clinical presentation. This report describes seven children (five boys, two girls and median age 10 [1.5-124] months) with ileal duplication cysts who presented with LGIB of varying severity from stool occult blood positivity with anemia to fresh bleeding per rectum. Diagnosis was made by Tc(99m) pertechnetate scan (n-5), balloon enteroscopy (n-1), and at laparotomy (n-1). Ultrasonography and barium meal follow-through missed the diagnosis in six and three cases, respectively. All cases underwent surgery with resection of the duplication cyst and complete removal of the mucosa containing ectopic gastric tissue while preserving adequate bowel length. A good postoperative outcome with complete symptom resolution was seen in all. Enteric duplication cyst should always be considered in children presenting with occult or overt lower gastrointestinal hemorrhage, and Tc(99m) pertechnetate scan should be done prior to invasive tests like balloon enteroscopy.
Collapse
Affiliation(s)
- Srikant Pandey
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | | | | | | | | |
Collapse
|
35
|
Importance of the ultrasonography in diagnosis of ileal duplication cyst. Gastroenterol Res Pract 2013; 2013:248625. [PMID: 24302931 PMCID: PMC3835361 DOI: 10.1155/2013/248625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal duplication cysts are rare congenital anomalies that can be seen in anywhere of the gastrointestinal system from the mouth to the anus. These are prenatally diagnosed through antenatal ultrasonography. However, attention must be paid since these formations might be confused with ovarian or mesenteric cysts. Our patient, who had been diagnosed with ovarian cyst on the ultrasonography performed in another center and with mesenteric cyst based on the abdominal MRI carried out at fifth month of life, presented to our clinic with the only complaint of constipation at 9th month of life. The diagnosis was set through double wall appearance of duplication cyst on the abdominal ultrasonography. The patient's cyst was resected.
Collapse
|
36
|
Temiz A, Oğuzkurt P, Ezer SS, İnce E, Gezer HÖ, Hiçsönmez A. Different clinical presentations, diagnostic difficulties, and management of cecal duplication. J Pediatr Surg 2013; 48:550-4. [PMID: 23480911 DOI: 10.1016/j.jpedsurg.2012.07.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cecal duplications (CDs) are very rare, representing 0.4% of all gastrointestinal duplications. This study evaluates the variable clinical presentations, imaging workup, and surgical management of CDs. METHODS The records of 7 patients who underwent surgery between April 2001 and December 2011 for CD were retrospectively reviewed. Sex, age, duration of complaints, diagnostic studies, surgical intervention, and pathologic findings were recorded. RESULTS The median age was 8 months, and mean age was 1.65 ± 2.88 years. Complaints were abdominal pain, rectal bleeding, vomiting, cough and dyspnea, and a prenatally detected cystic mass. The patients were referred with the diagnosis of appendicular abscess, necrotizing enterocolitis, gastrointestinal lymphoma, and intraabdominal cystic mass. Abdominal distention, signs of peritonitis, substernal retraction, fullness at right lower quadrant, and normal findings were detected on physical examination. Diagnostic imaging included plain abdominal radiography (7), ultrasonography (7), computed tomography (3), and magnetic resonance imaging (2). A cystic mass was reported on radiologic studies in 6 patients and appendicular abscess in 1. Cyst and cecum were resected, ileocolostomy was performed in 6 patients, and cyst excision was performed in 1. The diagnosis of duplication cyst was made by pathologic examination in all patients. CONCLUSIONS Cecal duplications may be detected incidentally; however, they may mimic appendicular abscess, a tumor mass, or necrotizing enterocolitis. Whether cystic lesions are symptomatic, they should be excised when detected because of possible complications.
Collapse
Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Koffie RM, Lee S, Perez-Atayde A, Mooney DP. Periampullary duodenal duplication cyst masquerading as a choledochocele. Pediatr Surg Int 2012; 28:1035-9. [PMID: 22752148 DOI: 10.1007/s00383-012-3116-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2012] [Indexed: 02/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Robert M Koffie
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
39
|
Mesenteric cysts associated with recurrent small-bowel volvulus: cause or effect? Jpn J Radiol 2012; 30:858-62. [PMID: 22986751 DOI: 10.1007/s11604-012-0131-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 08/26/2012] [Indexed: 12/14/2022]
Abstract
Recurrent small-bowel volvulus is a state of recurrent intermittent or long-standing persistent twisting of small-bowel loops around its mesentery. The association of mesenteric cysts with recurrent small-bowel volvulus as the cause or effect is a much debated issue in the literature. We report two cases of mesenteric lymphangioma and one case of enteric duplication cyst seen in association with recurrent small-bowel volvulus of long duration in absence of malrotation.
Collapse
|
40
|
Peng HL, Su CT, Chang CY, Lau BH, Lee CC. Unusual imaging features of completely isolated enteric duplication in a child. Pediatr Radiol 2012; 42:1142-4. [PMID: 22476620 DOI: 10.1007/s00247-012-2380-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/01/2012] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
We report a case of completely isolated enteric duplication in an 18-month-old boy in whom US revealed a reniform abdominal mass with a pseudokidney sign that had no connection to adjacent organs. Distinctive histopathological changes of the duplication account for these unusual imaging features. Our case represents a diagnostic challenge in this rare entity. To our knowledge, this is a unique case.
Collapse
Affiliation(s)
- Hui-Ling Peng
- Department of Diagnostic Radiology, Shin Kong Wu Ho Su Memorial Hospital, 95, Shihlin District (111), Taipei, Taiwan
| | | | | | | | | |
Collapse
|
41
|
Pachl M, Patel K, Bowen C, Parikh D. Retroperitoneal gastric duplication cyst: a case report and literature review. Pediatr Surg Int 2012; 28:103-5. [PMID: 22138979 DOI: 10.1007/s00383-011-3036-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 02/05/2023]
Abstract
A rare case of retroperitoneal gastric duplication is reported and discussed. An intra-abdominal cyst was detected at 31 weeks gestation and was followed up prenatally as a left sided duplex kidney. Post-natal ultrasound however, showed a normal kidney, but a cyst with features of enteric duplication in the left upper quadrant adjacent and compressing the kidney. Surgery was carried out during infancy and a retroperitoneal cyst was excised that contained heterotrophic gastric mucosa.
Collapse
Affiliation(s)
- Max Pachl
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | | | | | | |
Collapse
|
42
|
Crane GL, Hernanz-Schulman M. Current Imaging Assessment of Congenital Abdominal Masses in Pediatric Patients. Semin Roentgenol 2012; 47:32-44. [DOI: 10.1053/j.ro.2011.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
43
|
Prinsloo H, Loveland J, Grieve A, Andronikou S, Valli Omar M. Gastric duplication cysts as a rare cause of haematemesis: diagnostic challenges in two children. Pediatr Surg Int 2011; 27:1127-30. [PMID: 21359665 DOI: 10.1007/s00383-011-2864-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2011] [Indexed: 11/26/2022]
Abstract
Gastric duplication cysts are rare congenital alimentary tract anomalies. We describe the importance of imaging in two children with haematemesis due to gastric duplication cysts. We emphasize the necessity for a high clinical index of suspicion for early diagnosis.
Collapse
Affiliation(s)
- Hendrik Prinsloo
- Department of Diagnostic Radiology, University of Witwatersrand, York Road, Parktown, Johannesburg, South Africa.
| | | | | | | | | |
Collapse
|
44
|
Unusual noncommunicating isolated enteric duplication cyst in adults. Gastroenterol Res Pract 2011; 2011:323919. [PMID: 21687617 PMCID: PMC3113256 DOI: 10.1155/2011/323919] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 03/10/2011] [Indexed: 12/14/2022] Open
Abstract
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.
Collapse
|
45
|
Lee NK, Kim S, Jeon TY, Kim HS, Kim DH, Seo HI, Park DY, Jang HJ. Complications of congenital and developmental abnormalities of the gastrointestinal tract in adolescents and adults: evaluation with multimodality imaging. Radiographics 2011; 30:1489-507. [PMID: 21071371 DOI: 10.1148/rg.306105504] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Seo-Gu, Busan, Korea
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Ackerman SJ, Irshad A, Anis M. Ultrasound for pelvic pain II: nongynecologic causes. Obstet Gynecol Clin North Am 2011; 38:69-83, viii. [PMID: 21419328 DOI: 10.1016/j.ogc.2011.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute pelvic pain in women is a common presenting complaint that can result from various conditions. Because these conditions can be of gynecologic or nongynecologic origin, they may pose a challenge to the diagnostic acumen of physicians, including radiologists. A thorough workup should include clinical history, physical examination, laboratory data, and appropriate imaging studies, all of which should be available to the radiologist for evaluation. Ultrasound is the primary imaging modality in women with acute pelvic pain because of its high sensitivity, low cost, wide availability, and lack of ionizing radiation, particularly when a gynecologic disorder is suspected as the underlying cause. However, other modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) may be very helpful, especially when a nongynecologic condition is suspected.
Collapse
Affiliation(s)
- Susan J Ackerman
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | |
Collapse
|
47
|
A case of perforated multiple gastric duplication cysts with five-layered appearance on ultrasonography. J Med Ultrason (2001) 2011; 38:47-51. [PMID: 27278339 DOI: 10.1007/s10396-010-0282-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 08/02/2010] [Indexed: 10/19/2022]
Abstract
A case of perforated multiple gastric duplication cysts is presented. One of the gastric duplication cysts without perforation was seen on ultrasonography (US) with the following specific findings of gastric duplication cysts: a five-layered appearance, fold-like structures in the wall, and blood supply from the gastroepiploic artery. Other cysts with perforation presented with irregular and thin walls with a lack of the "double-wall sign" on US. These characteristic findings may be specific to perforated multiple gastric duplication cysts.
Collapse
|
48
|
|
49
|
Maheshwari P, Abograra A, Shamam O. Sonographic evaluation of gastrointestinal obstruction in infants: a pictorial essay. J Pediatr Surg 2009; 44:2037-42. [PMID: 19853770 DOI: 10.1016/j.jpedsurg.2009.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/09/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
Traditionally, gastrointestinal contrast studies have been the mainstay of evaluating infantile gastrointestinal problems. Because of technological advancements, good ultrasonography (USG) machines can provide high-resolution images with graphic anatomical clarity, especially in infants and children and thus change the traditional diagnostic trends. In this article, we illustrate the USG appearances of various causes of gastrointestinal obstruction in infants and discuss the role of USG in their evaluation.
Collapse
|
50
|
Kim YJ, Kim YK, Jeong YJ, Moon WS, Gwak HJ. Ileal duplication cyst: Y-configuration on in vivo sonography. J Pediatr Surg 2009; 44:1462-4. [PMID: 19573681 DOI: 10.1016/j.jpedsurg.2009.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/19/2009] [Accepted: 03/23/2009] [Indexed: 01/07/2023]
Abstract
Although the double wall or muscular rim sign is considered to be a characteristic sonographic imaging finding of an enteric duplication cyst, this sign can also be produced by Meckel's diverticulum and sonographic artifacts. The Y-configuration on in vitro sonography has been reported to be useful for the definitive diagnosis of an enteric duplication cyst. Here, we report a case of an intraoperatively confirmed ileal duplication cyst that was correctly diagnosed before by identification of the Y-configuration on in vivo sonography.
Collapse
Affiliation(s)
- Young Jun Kim
- Department of Radiology, Chonbuk National University Medical School, Jeonju 561-712, South Korea
| | | | | | | | | |
Collapse
|