Multiple Enteric Duplication Cysts in a Twin Fetus : Diagnosis and Management = الكيسات المعوية المضاعفة المتعددة في جنين توأم : التشخيص و العلاج

Abstract

Enteric duplication cysts are rare congenital anomalies of the gastrointestinal tract. These can be suspected if cystic lesions are noted in the fetal abdomen during an antenatal ultrasonogram. The differential diagnoses of fetal intra-abdominal cystic lesions include fetal omental cysts, fetal mesenteric cysts, meconium pseudocysts and fetal ovarian cysts. We report an antenatally diagnosed enteric duplication cyst in one of a set of twin fetuses which was managed successfully.

Altering Appearance of Fetal Enteric Duplication Cysts: The Gut Signature Sign and Other Indications for Prenatal Diagnosis

“…The gut signature sign is a term used to describe the appearance of the gastrointestinal wall. It represents five layers, corresponding to the innermost hyperechoic mucosa, hypoechoic muscularis mucosa, hyperechoic submucosa, hypoechoic muscularis propria, and the outermost hyperechoic serosa [1][2][3]. However, not all five layers are detectable consistently; the term then also refers to a hyperechoic inner layer, representing the mucosa, surrounded by a hypoechoic external layer, representing the muscular layer [2,4,5].…”

“…However, not all five layers are detectable consistently; the term then also refers to a hyperechoic inner layer, representing the mucosa, surrounded by a hypoechoic external layer, representing the muscular layer [2,4,5]. Therefore, it rather presents as a bi-layer in the prenatal setting [1,4,6]. When the direction of the high frequency ultrasound beam is perpendicular to (90 degrees) the cyst wall, the gut signature sign tends to be more evident as a result of receiving more beam reflections from the cyst wall.…”

“…Despite their substantial postnatal impact, antenatal scans have been reported to identify only 20-30% of such cases. [1] Although the gut signature sign is considered to be relatively specific in the diagnosis of enteric duplication cysts, the classic five-layered appearance is not always easy to demonstrate in the prenatal setting. Owing to the diminished permeability of the ultrasonic beam through duplication cysts, their walls are detected as simple, linear linings.…”