Abstract:Due to the variability in the site of enteric duplications, a wide range of presenting symptoms can exist, which is challenging for diagnosis. In children with a diagnosis of acute abdomen, enteric duplication cysts should be considered, and these children should be further investigated for additional skeletal, urogenital, and gastrointestinal system pathologies. Surgical treatment depends on the site and type of the cyst.
“…Minimally invasive techniques are recent strategies for management [ 26 ]. The procedures usually involve bowel resection; otherwise, simple enucleation or removal of cyst is available for the foregut lesions [ 26 27 28 ]. For all cases in this study, a segmental resection including the lesion was performed.…”
Purpose: Alimentary tract duplication (ATD) is a rare congenital condition that may occur throughout the intestinal tract. Clinical symptoms are generally related to the involved site, size of duplication, or associated ectopic mucosa. This study aimed to identify clinical implications by anatomical locations and age group and then suggest a relevant management according to its distinct features. Methods: We retrospectively reviewed the clinical data of pediatric patients who received a surgical management due to ATD. Furthermore, data including patients' demographics, anatomical distribution of the duplication, clinical features according to anatomical variants, and outcomes were compared. Results: A total of 25 patients were included in this study. ATD developed most commonly in the midgut, especially at the ileocecal region. The most common clinical presentation was abdominal pain, a sign resulting from intestinal obstruction, gastrointestinal bleeding, and intussusception. The non-communicating cystic type was the most common pathological feature in all age groups. Clinically, prenatal detection was relatively low; however, it usually manifested before the infantile period. A laparoscopic procedure was performed in most cases (18/25, 72.0%), significantly in the midgut lesion (p=0.012). Conclusion: ATD occurs most commonly at the ileocecal region, and a symptomatic one may usually be detected before the early childhood period. Surgical management should be considered whether symptom or not regarding its symptomatic progression, and a minimal invasive procedure is the preferred method, especially for the midgut lesion.
“…Minimally invasive techniques are recent strategies for management [ 26 ]. The procedures usually involve bowel resection; otherwise, simple enucleation or removal of cyst is available for the foregut lesions [ 26 27 28 ]. For all cases in this study, a segmental resection including the lesion was performed.…”
Purpose: Alimentary tract duplication (ATD) is a rare congenital condition that may occur throughout the intestinal tract. Clinical symptoms are generally related to the involved site, size of duplication, or associated ectopic mucosa. This study aimed to identify clinical implications by anatomical locations and age group and then suggest a relevant management according to its distinct features. Methods: We retrospectively reviewed the clinical data of pediatric patients who received a surgical management due to ATD. Furthermore, data including patients' demographics, anatomical distribution of the duplication, clinical features according to anatomical variants, and outcomes were compared. Results: A total of 25 patients were included in this study. ATD developed most commonly in the midgut, especially at the ileocecal region. The most common clinical presentation was abdominal pain, a sign resulting from intestinal obstruction, gastrointestinal bleeding, and intussusception. The non-communicating cystic type was the most common pathological feature in all age groups. Clinically, prenatal detection was relatively low; however, it usually manifested before the infantile period. A laparoscopic procedure was performed in most cases (18/25, 72.0%), significantly in the midgut lesion (p=0.012). Conclusion: ATD occurs most commonly at the ileocecal region, and a symptomatic one may usually be detected before the early childhood period. Surgical management should be considered whether symptom or not regarding its symptomatic progression, and a minimal invasive procedure is the preferred method, especially for the midgut lesion.
“…In the context of gastrointestinal bleeding, Tc-99m pertechnetate radionuclide scan is liable to discern the heterotopic gastric mucosa, which aids in the discrimination of Meckel's diverticulum from a duplication when locating on the antimesenteric border of the small bowel, with an up to 75% sensitivity. [ 37 ] Nonetheless, it is worth noting that heterotopic gastric mucosa does emerge in only 20% to 30% of duplication cysts, [ 38 ] which dramatically limits the detectable usefulness of isotope studies. [ 39 ] Enhanced CT scan is a more common and desirable imaging tool, offering further characteristics of the lesion along with delineation of the surrounding structures, [ 33 ] which most likely indicates the necessity of immediate management.…”
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.
“…Extrinsic compression of the adjacent bowel is also possible, which causes obstruction. However, the most serious complications are produced if gastric mucosa is present within the cyst, leading to inflammation, bleeding, ulceration and even perforation [ 6 , 9 , 13 , 14 , 24 , 25 ]. Fig.…”
Section: Clinical Presentationsmentioning
confidence: 99%
“…The clinical behaviour of EDCs is unpredictable. EDCs tend to increase in size gradually and can cause symptoms and important complications that might be fatal, such as obstruction, massive bleeding or even a potential risk for malignant transformation in the adulthood [ 13 , 14 , 17 , 39 ].…”
Section: Managementmentioning
confidence: 99%
“…The mucosal lining does not always correlate with the adjacent gastrointestinal tissue, but the duplications are named according to the part of the GT to which these are intimately attached. Ectopic gastric mucosa is found in 20–30% of these cysts, more frequently in oesophageal and small bowel duplications [ 13 , 14 ]. Prominent gastric mucosa can also be seen as a polypoid mass covering the base of the cyst, being transmural (Fig.…”
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.
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