Print this page Email this page
Users Online: 697
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 3  |  Issue : 3  |  Page : 226-228

Enteric duplication cyst in an 8 year old child


1 Department of Surgery, Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
2 Department of Pathology, Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication28-Mar-2014

Correspondence Address:
Siddharth Pramod Dubhashi
A-2/103, Shivranjan Towers, Someshwarwadi, Pashan, Pune - 411 008, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.129570

Rights and Permissions
  Abstract 

Enteric duplications are rare congenital anomalies that can occur along the entire length of the gastrointestinal system. Their most common location is the small intestine, mostly the terminal ileum. Almost 70% of the cases present within 1 st year of life. The common symptoms include abdominal pain, vomiting, distension and constipation. Ultrasound, computed tomography scan and magnetic resonance imaging are useful in diagnosing the lesion. Excision of the duplication cyst is the treatment of choice. This is a case report of an 8-year-old male child who presented with enteric duplication cyst, which was attached to the terminal ileum with no communication with the bowel lumen. The cyst was excised and the child made a satisfactory recovery.

Keywords: Duplication cyst, enteric duplication, ileum


How to cite this article:
Dubhashi SP, Sindwani RD, Jadhav S, Kumar H. Enteric duplication cyst in an 8 year old child. Arch Int Surg 2013;3:226-8

How to cite this URL:
Dubhashi SP, Sindwani RD, Jadhav S, Kumar H. Enteric duplication cyst in an 8 year old child. Arch Int Surg [serial online] 2013 [cited 2019 Aug 24];3:226-8. Available from: http://www.archintsurg.org/text.asp?2013/3/3/226/129570


  Introduction Top


Enteric duplications are rare congenital anomalies that can occur along the entire length of the gastrointestinal system. They are defined by their histological appearance, which mimics that of the native gastrointestinal tract possessing an inner mucosa-submucosa layer surrounded by an outer smooth-muscle layer. [1] The commonest location is the small intestine, usually the terminal ileum. The estimated incidence is 1:4500 newborns. [2],[3] Duplications of ileum appear as non-communicating spherical cysts. They are mistaken for mesenteric cysts, but are recognised by mucosal lining. [4] The objective of this paper was to discuss the clinical presentation, investigations, diagnosis and treatment of an 8-year-old child that presented with a duplication cyst of the ileum.


  Case Report Top


This is a case report of an 8-year-old male child who presented with recurrent colicy pain in the abdomen for 3 years and periodic episodes of bilious vomiting. There was no history of fever or any other major illness. On examination, there was a tense cystic mass in the right iliac fossa with tenderness on deep palpation. No other abnormal finding on examination.

Haematological and biochemical investigations were within the normal limits. Ultrasound of the abdomen showed a round 2.8 cm × 2.6 cm × 1.8 cm well defined anechoic cystic structure on the right periumbilical region, with thin septa within just beneath the subcutaneous tissue adjacent to the small bowel loops, suggestive of mesenteric cyst or enteric duplication cyst. Computed tomography (CT) scan of the abdomen showed a smooth, rounded, fluid-filled cystic lesion with thin slightly enhancing wall [Figure 1].
Figure 1: Computed tomography scan abdomen

Click here to view


Patient had exploratory laparotomy. There was a 5 cm × 3 cm cyst, 10 cm proximal to ileo-ceacal junction with adhesions between the cyst and ileo-ceacal junction and anterior abdominal wall. The base of the cyst was attached to the terminal ileum, but was not communicating with the bowel lumen. The cyst was excised completely. The continuity of the underlying bowel was maintained and the seromuscular defect was closed [Figure 2] and [Figure 3].
Figure 2: Duplication cyst proximal to ileo-cecal junction

Click here to view
Figure 3: Cut section of cyst

Click here to view


The cyst contained clear serous fluid. Cut section of the cyst showed small bowel mucosal lining. Microscopically, the cyst was lined by low columnar to cuboidal atrophic mucosa with mild sub-epithelial round cell infiltration and a well-developed smooth muscle coat [Figure 4] and a histological diagnosis of intestinal duplication cyst was made.
Figure 4: Histopathological picture showing intestinal layers

Click here to view



  Discussion Top


Reginald Fitz first used the word "duplication" in 1884, to describe the remnants of the omphalo-mesenteric duct. [5] The term "alimentary tract duplication" was coined by W.E. Ladd to describe those congenital malformations that are seen on the mesenteric side of the associated alimentary tract and share a common blood supply with the native bowel. [6] The duplication is explained as a defect in the recanalization of the intestinal lumen after the solid stage of the embryological development. [4] Other theories include-persisting embryological diverticula or "aborted Gemini," intrauterine vascular accident theory. [7] The lesions are classified as: (1) Classical, with the shared common wall and blood supply (2). Completely isolated from the bowel, which has an independent blood supply (3) Intermediate, with part of the duplication independent and part of its sharing a common wall with bowel. [2] The lesion seen in our case was of an intermediate type. The vascular classification to facilitate surgical management divides the enteric duplications into - Type I (parallel) with the duplication located on the border of one mesenteric leaf and the straight artery to the duplication is separated from the straight artery to the bowel, Type II (intramesenteric) with the duplication located between the two leaves of the mesentery and the straight arteries pass over both surfaces of the duplication to reach the adjacent bowel. [8]

Almost 70% of the enteric duplications that present with symptoms do so within the 1 st year of life and 85% by 2 years of age. [3] The common symptoms include abdominal pain, vomiting, distension and constipation. Small cystic duplications can act as a lead point for small bowel intussusception or result in localized volvulus. Larger duplications can cause compression of adjacent intestine and cause obstructive symptoms. A malignant change can occur within the intestinal duplication. [7] Ultrasound, CT scan and magnetic resonance imaging (MRI) are useful in diagnosing the lesion. Ultrasound shows the double wall or muscular rim sign with an echogenic inner margin corresponding to the mucosa surrounded by a hypoechoic rim of tissue representing the smooth muscle layer. [1] The lesion manifests as a smooth rounded, fluid filled cysts or tubular structure with thin slightly enhancing wall on CT scan. MRI scan shows intracystic fluid with heterogeneous signal density on T1-weighted image and homogenous high signal intensity on T2-weighted image.

Due to the possible complications such as bowel perforation, bleeding, obstruction and malignant change, intestinal duplications require surgical intervention. Excision of the duplication is the treatment of choice. Small cystic or short tubular duplication can be managed with segmental resection along with adjacent bowel. Long tubular duplications will require mucosal stripping through a series of multiple incisions. [9] In our case, the cyst had no communication with the bowel lumen and hence, bowel resection was not required.


  Conclusion Top


Enteric duplication cysts are rare congenital anomalies that have a varied clinical presentation. Early diagnosis and treatment reduces the risk of complications. Resection of the duplication cyst is the treatment of choice.

 
  References Top

1.Cheng G, Soboleski D, Daneman A, Poenaru D, Hurlbut D. Sonographic pitfalls in the diagnosis of enteric duplication cysts. AJR Am J Roentgenol 2005;184:521-5.  Back to cited text no. 1
    
2.Prada Arias M, García Lorenzo F, Montero Sánchez M, Muguerza Vellibre R. Enteric duplication cyst resembling umbilical cord cyst. J Perinatol 2006;26:368-70.  Back to cited text no. 2
    
3.Gálvez Y, Skába R, Kalousová J, Rousková B, Hríbal Z, Snajdauf J. Alimentary tract duplications in children: High incidence of associated anomalies. Eur J Pediatr Surg 2004;14:79-84.  Back to cited text no. 3
    
4.Chaudhary S, Raju U, Harjai M, Gupta M. Intestinal duplication cyst. Med J Armed Forces India 2006;62:87-8.  Back to cited text no. 4
    
5.Bower RJ, Sieber WK, Kiesewetter WB. Alimentary tract duplications in children. Ann Surg 1978;188:669-74.  Back to cited text no. 5
[PUBMED]    
6.Ladd WE, Gross RE. Surgical treatment of duplications of the alimentary tract. Surg Gynaecol Obstet 1940;70:295-307.  Back to cited text no. 6
    
7.Blank G, Königsrainer A, Sipos B, Ladurner R. Adenocarcinoma arising in a cystic duplication of the small bowel: Case report and review of literature. World J Surg Oncol 2012;10:55.  Back to cited text no. 7
    
8.Li L, Zhang JZ, Wang YX. Vascular classification for small intestinal duplications: Experience with 80 cases. J Pediatr Surg 1998;33:1243-5.  Back to cited text no. 8
    
9.Bond SJ, Graff DB. Gastrointestinal duplications. In: O Neil JA, Grosfeld JL, Tanskalsrud EW, Coran AG, editors. Paediatric Surgery. 5 th ed. Mosby; 1998. p. 1257-63.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1285    
    Printed34    
    Emailed0    
    PDF Downloaded136    
    Comments [Add]    

Recommend this journal