Cysts and Diverticula of Intestinal Origin

Abstract

Cysts and diverticula arising from the gastro-intestinal tract constitute a group of congenital malformations which not only present problems in clinical diagnosis but are of pathologic interest on account of their origin. The problem is still in a controversial state, particularly from the standpoint of the origin of certain of these anomalies.The typical Meckel's diverticulum is single and arises from the antimesenteric border of the ileum. It may lie free in the peritoneal cavity, attached only at its point of origin from the bowel, or may exist as a patulous duct or a fibrous cord connecting the intestinal tract with the umbilicus or as a blind sac or cord attached to adjacent structures in the abdomen. Besides this classic type of fetal remnant of the vitelline duct, cysts of enterogenous origin have been described on the same embryologic basis. These may occur in the region of the umbilicus, in the abdomen independent of the mesentery or merely attached to it. Little has been added to the knowledge of the origin of this group of anomalies since Meckel's monograph.1 However, another type of the diverticulum and cyst of gastro¬ intestinal origin has been described, which, because of its position or its unusual relation to the gastro-intestinal tract, is separable from the type described by Meckel and subsequent writers on the subject.From the standpoint of the origin of this group of anomalies the authors are divided into two schools, namely, those who consider all enterogenous cysts and diverticula as arising from remains of the vitel¬ line duct, and those who consider the intramesenteric cysts and diver¬ ticula, duplications of the esophagus, mediastinal enterogenous cysts and duplications of the colon as having an independent mode of origin.The following case brings up the controversial points involved and illustrates the usual clinical syndrome encountered.From the

An unusual foregut anomaly an extragastric pouch communicating with the pancreatic duct

“…Further cases in the same category were reported by Poncher and Milles (1933), Davis and Salkin (1947), and Gross, Neuhauser, and Longino (1950). Recently Roberts and Weeks (1957) have added z more cases to the literature.…”

Enterogenous cyst of the ileum

“…I t is apparently rare for cysts in this region to communicate with the bowel. Mehn Mehn and Morrow also state that melaena is a rare method of presentation, but Poncher and Milles (1933) refer to a case in which there was " a profuse hzmorrhage during infancy and no further symptoms until the age of 18, when the patient died as the result of marked intestinal bleeding or shock ". Dohn and Povlsen (1951) maintain that " the presence of an intra-abdominal enterocystoma is a perilous condition" and state that over one-fourth of the recorded cases had proved fatal.…”

Duplication of Two Parts of the Alimentary Tract

“…8 Retroperitoneal but not connected with alimentary tract. 4 Preperitoneal (in relation to umbilicus).…”