Perforated ileal duplication cyst with haemorrhagic pseudocyst formation

Abstract

Duplication cysts of the gastrointestinal tract are rare congenital abnormalities. Ectopic gastric mucosa, which can be found in duplications, may cause peptic ulceration, gastrointestinal bleeding or perforation. We report a 1-year-old boy with a perforated ileal duplication cyst with haemorrhagic pseudocyst formation caused by peptic ulceration of the duplication cyst. It presented a snowman-like appearance consisting of a small, thick-walled, true enteric cyst and a large, thin-walled haemorrhagic pseudocyst on US and CT. It is an unusual manifestation of a duplication cyst, which has not been reported in the English language literature.

Obstructing ileal duplication cyst infected with Salmonella in a 2-year-old boy: a case report and review of the literature

“…Ileal duplication cysts can perforate and have even been reported to form pseudocysts [11]; however, an infected ileal duplication cyst has not been reported in the literature nor a duplication cyst infected with Salmonella. One report exists of an infected duodenal duplication cyst, which was treated by percutaneous drainage and subsequent resection.…”

Omental pseudocyst formation associated with perforated gastric duplication: a case report

“…In general, pseudocysts develop as posttraumatic intraabdominal cysts or as a result of other related intraabdominal pathology [6,7]. The development of hemorrhagic pseudocyst from a perforated ileal duplication and complicated by peptic ulceration is a rare occurrence [8]. The etiology of omental pseudocysts has been attributed to segmental torsion of the greater omentum, infarction of the greater omentum caused by occlusion of an artery such as the superior mesenteric artery, or secondary change to the organization of a hematoma within the greater omentum after blunt abdominal trauma [6,7].…”

Aspectos morfológicos en tomografía computada de un quiste de duplicación intestinal en adulto: Reporte de caso clínico y revisión de la literatura.

“…Las complicaciones descritas incluyen perforación, invaginación intestinal, vólvulo, obstrucción intestinal por compresión extrínseca de estructuras adyacentes, hemorragia digestiva y, en menor frecuencia, transformación maligna (2)(3)(4)6,(9)(10)(11) . Inoue y Nakamura reportaron 18 casos de transformación maligna de quistes de duplicación entéricos, con rango de edad entre 33 y 65 años, siendo el colon el segmento asociado a mayor malignización (67%), tratándose principalmente de adenocarcinomas (3,11) .…”

“…En TCMC, estas lesiones pueden presentar aspecto de masa quística adyacente al tracto gastrointestinal, que no realza con contraste intravenoso, en ocasiones con loculaciones en su interior. La mayoría de las veces, presentan atenuación de líquido, sin embargo ocasionalmente pueden alcanzar una mayor densidad por contenido rico en proteínas o sangre (1)(2)(3)5,7,(9)(10)(11) . En RM por su naturaleza quística se comportan hipointensos en T1 e hiperintensos en T2, con realce anular; de existir hemorragia, infección o comunicación con el tracto gastrointestinal, la señal de T1 puede ser variable (2,3,12) .…”

“…Dependiendo de su localización, también es posible considerar como alternativas: quiste de colédoco, pseudoquiste pancreático, quistes ováricos y mucocele apendicular (2,3,5,6,8,9,13) . El tratamiento de elección es quirúrgico (5) .…”