Prenatal detection of isolated gastric duplication cyst

Repeated ultrasound tests could be used to identify an isolated gastric duplication cyst before surgery

A toddler girl was diagnosed with intra-abdominal simple cyst in the splenic flexure at the gestational period. Due to a severe fever that persisted for 6 days, she was admitted to the emergency room. The diagnosis of intraperitoneal cyst infection was made after contrast-enhanced CT revealed an enlarged cyst and a heterogeneous contrast effect on the cyst wall. A double-wall sign was observed on the cyst wall during continuous ultrasound follow-up, which led to the preoperative diagnosis of the cyst as a duplication cyst. The double-wall sign and cyst peristalsis were identified via successive ultrasound examinations to support the cyst diagnosis. Identifying a duplication cyst based solely on symptoms alone is difficult because the condition may present in different ways.

Laparoscopic excision of a very rare isolated gastric enteric duplication cyst: case report and literature review

Background

Gastric duplication cysts are a very rare variant of all enteric duplications, and their isolated forms are much rarer developmental anomalies in the form of case reports only. In this study, a 4-month-old male patient, who was diagnosed with an intra-abdominal cystic mass in his antenatal examination and laparoscopic excision of the isolated gastric duplication was presented.

Case presentation

A 4-month-old male patient was born at 39 weeks of gestation, 3180 g. When a 37 × 17mm intra-abdominal cystic mass was detected in the detailed ultrasonography (USG) performed at the 20th week of his antenatal examination, he was followed up in another center with the preliminary diagnosis of mesenteric cyst and intestinal duplication cyst. It was learned that the patient had transient constipation and vomiting in his history. Physical examination revealed a mobile, smooth-surfaced 5-cm mass on palpation in the lower midline of the abdomen. Control ultrasonography revealed a lobulated contoured cystic lesion measuring 59 × 30 × 23 mm, with a multilayered wall structure and debris inside. In laparoscopy, the mass is mobile, thick-walled, cystic in appearance, isolated from surrounding tissues. It was observed that it was attached to the sigmoid colon mesentery with a handle. The thick peduncle containing the feeding vessels was closed and cut, preserving the mesentery. Thick mucoid cyst contents were aspirated with a percutaneous needle. The shrinking cyst was removed from the abdomen by enlarging the working opening of 5 mm. The macroscopic appearance was consistent with intestinal duplication cyst. The patient was fed orally at the 2nd hour postoperatively and was discharged at the 10th hour. In the pathological examination, gastric duplication cyst was diagnosed due to the type of gastric lining epithelium. No recurrence or additional pathology was detected in the control ultrasonography in the 6-month follow-up postoperatively.

Conclusion

Laparoscopic exploration should be considered as the first surgical option in asymptomatic, growing intra-abdominal cystic masses with a preliminary diagnosis of duplication cysts. The advantages of laparoscopy can make important contributions to patient management.

Prenatal Assessment of Atypical Adrenal Glands: A Systematic Approach for Diagnosis

The aim of this study was to identify specific unusual prenatal ultrasound (US) patterns of the adrenal gland and to propose a systematic approach for diagnosis. Six fetuses with unusual aspects of one or both adrenal glands, detected during routine prenatal US screening, were evaluated. Prenatal and postnatal management are described. A checklist of US features was created to perform a detailed analysis of adrenal lesions and guide prenatal management; this includes the time of appearance, location, growth, vascularization, structure, and presence of findings suggestive of malignancy.

A retroperitoneal supra-adrenal non-communicating gastric duplication cyst: a case report and comprehensive literature review

Background

Gastric duplication cyst is a rare congenital anomaly. It is usually located in close proximity to the stomach. Nevertheless, there have been seldom reports in the literature that describe unusual locations. Retroperitoneal gastric duplications cysts are extremely rare and are usually confused with renal or adrenal cysts.

Case presentation

In this case report, we are presenting a 2-year-old girl with a complaint of bouts of abdominal pain, found to have a retroperitoneal supra-adrenal cyst on imaging. She underwent laparoscopic resection of the cyst with uneventful post-operative course. The histopathological diagnosis was surprisingly gastric duplication cyst.

Conclusion

In our review of the literature, the variability of this condition and its clinical manifestation are apparent. We also conclude that this diagnostic entity should be part of the differential diagnosis of intraperitoneal or retroperitoneal cysts and that laparoscopic resection of retroperitoneal cysts is the preferred approach.

A Case of Intrathoracic Gastric Duplication Cyst Detected on Prenatal Ultrasound Examination

A 37-year-old (G4P3) woman was referred to our hospital at 32 weeks of gestation for the evaluation of a fetus with an intrathoracic cystic lesion. Ultrasonography and magnetic resonance imaging revealed that a fetal cystic lesion without a mucosal layer was located in the posterior mediastinum. These findings were consistent with a bronchogenic cyst. At 38 3/7 weeks of gestation, an elective cesarean section was performed because of her previous cesarean section. A female neonate without any external anomalies, weighing 2,442 g, with Apgar scores of 8 and 9, and requiring no resuscitation was born. Four weeks after delivery, the neonate was admitted because of respiratory distress due to mass effect. At right lateral thoracotomy, a 105 × 65 mm of solitary smooth-walled cyst containing serosanguineous fluid was found in the posterior mediastinum, which was excised completely. Histologic examination revealed the diagnosis of the mediastinal gastric duplication cyst. The neonate made an uneventful recovery. Accurate diagnosis is not necessary, but detection and continuous observation are logical. Although gastric duplication, particularly intrathoracic, is a rare pathology, it should be considered in the differential diagnosis of any intrathoracic cyst.

Prenatal and postnatal evolution of isolated fetal splenic cysts

OBJECTIVES

The aim of this study was to evaluate the prevalence, the prenatal, and postnatal evolution of isolated fetal splenic cysts.

METHODS

All cases of suspected fetal splenic cyst or abdominal unidentified cyst discovered during routine ultrasound scan, from 2007 to 2017, and referred to a French tertiary care center, were retrospectively collected. For each case, several prenatal parameters and postnatal evolution were reported.

RESULTS

Among 5450 cases of fetal anomalies, 14 patients (0.3%) had a prenatal diagnosis of fetal splenic cysts. Median gestational age at diagnosis was 30.1 weeks. A unique cyst was present in 78.6%, whereas 2 cysts were observed in 14.3% and 3 cysts in 7.1%. During the pregnancy, cysts remained the same (78.6%) or disappeared (21.4%). Ultrasound scans at 6 months of age found total disappearance of the cysts (36.4%), spontaneous reduction from 2 to 1 cyst (18.2%) or persistence of the cysts (45.4%).

CONCLUSION

Fetal splenic cysts are rare images, always isolated, usually unique and mainly found during third trimester of pregnancy. Their evolution is to disappear spontaneously during pregnancy or at 6 months of age leaving only half of them to remain beyond that age but without any symptoms.

A Retroperitoneal Isolated Enteric Duplication Cyst Mimicking a Teratoma: A Case Report and Literature Review

Enteric duplication cysts lacking anatomic association with the gastrointestinal tract are called isolated enteric duplication cysts (IEDCs). We present an atypical case of a retroperitoneal IEDC with a tortuous tubular complex shape that enfolded the surrounding retroperitoneal fat and mimicked a retroperitoneal teratoma. Multiplanar reconstruction images should be used to evaluate such a lesion correctly. A tortuous tubular complex shape could be a key finding to differentiate from other retroperitoneal cysts.

A Rare Cause of Intestinal Obstruction in Infants: Ileum Duplication Cyst and Literature Review

Cases of neonatal gastrointestinal system (GIS) obstruction are quite complex for pediatric surgery clinics. A rare cause of intestinal obstruction is the duplication cyst (DC). A three-day-old male patient presented at our clinic with a history of abdominal distension and bilious vomiting on the second day following birth. Although pathology had not yet been determined from observation and examination, surgery was performed when the patient could not tolerate oral feeding. An ileal DC forming an incomplete obstruction was observed. Ileoileal anastomosis was performed on the patient. Because DCs can present with different clinical symptoms, it is quite difficult to diagnose them in neonate patients. Lacking an imaging method that can provide an exact diagnosis, the diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment.

Gastric duplication cyst as a differential for an intra-thoracic cystic mass

We report a case of a neonate who presented with respiratory distress initially managed for a suspected pneumothorax before being transferred to a tertiary centre where he had a thoracotomy. A large cystic structure was excised later histologically confirmed to be a gastric duplication cyst. We discuss its management.

A retroperitoneal enteric duplication cyst communicating with the right upper ureter in an infant

We report an extremely rare case of isolated retroperitoneal enteric duplication cyst with gastric mucosa causing haematuria and dysuria by communicating with the urinary system. A 9-month-old male child was admitted to our hospital with persistent haematuria, dysuria and anaemia. Investigations revealed a retroperitoneal cyst abutting the hydronephrotic non-functioning right kidney. At surgery an isolated retroperitoneal cyst communicating with the right pelviureteric junction was found. The kidney and associated cyst were excised. Histology of the cystic lesion revealed an enteric duplication cyst lined by ectopic gastric mucosa. Isolated retroperitoneal enteric duplication cyst communicating with the urinary tract has not been previously reported in the English literature. We propose that acid secretion into the right renal system was the cause of the haematuria-dysuria syndrome which promptly resolved postoperatively.

Two isolated giant gastric duplication cysts in thorax in a newborn

We report a case of a newborn with severe respiratory distress since birth with two giant intrathoracic and separate eneteric duplication cysts in right hemithorax. On day 19, the intrathoracic cysts were removed, and the baby was discharged on his 22nd day of life. Histologic findings confirmed the diagnosis of a gastric duplication cyst. This report is the first case of two isolated, separated and giant right intrathoracic gastric duplication cysts in literature. The diagnostic values of radiological evaluation and surgical and pathological management for precise diagnosis are discussed.

Imaging and differential diagnosis of suprarenal masses in the fetus

Prenatal sonography and magnetic resonance imaging of suprarenal fetal masses is presented, along with clinical information and follow-up. Imaging pearls and differential considerations for each diagnosis will be discussed. Fetal suprarenal mass diagnoses include neuroblastoma, extralobar pulmonary sequestration, congenital adrenal hyperplasia, partial multicystic dysplastic kidney, renal duplication, urinoma, gastric duplication cyst, and splenic cyst. Recognizing the range of malignant and benign suprarenal fetal masses that can present on prenatal imaging can help guide patient counseling and management.

Prenatal sonographic findings of duodenal duplication: case report

We report a rare case of duodenal duplication cyst that was suspected prenatally. Routine prenatal sonography (US) at 19 weeks' gestation showed an abdominal cystic mass on the left side of the abdomen. Follow-up US examinations showed a partial "double-wall" sign, highly suggestive of enteric duplication, and changes in cyst size and wall thickness. Postnatal US examination suggested enteric duplication cyst. A laparotomy revealed a duodenal cyst that was completely resected. The antenatal US findings associated with this condition, the accuracy of its antenatal diagnosis, and its differential diagnosis are discussed.

Infected completely isolated enteric duplication cyst management with percutaneous drainage and surgical excision after retreat of infection: a case report

Duplication cysts (DCs) of alimentary tract are rare congenital malformations. They are firmly attached to the wall of the gastrointestinal tract and they are supplied by surrounding mesenteric blood vessels. More than 80% of cases occur before the age of two years and only a minority of cases present in adulthood. “Completely isolated duplication” of the alimentary tract is an extremely rare variety of gastrointestinal duplications. They have gastrointestinal epithelial and wall characteristics without an anatomic association with the alimentary tract. Their main characteristic is that they have their own blood supply. A 20-year-old male was admitted to our department with symptoms persisting for a period of one week prior to admission, which included abdominal pain, fever, and a palpable abdominal mass. CT revealed an unexplained intraperitoneal abscess. This case represents a rare clinical example of infected isolated duplication cyst managed with percutaneous drainage and surgical excision of the cyst 3 weeks later. To the best of our knowledge, this is the first reported case to use this approach.

Completely isolated enteric duplication cyst associated with a classic enterogenous duplication cyst

This report describes an 18-month-old boy with a completely isolated duplication cyst (CIDC) of the ileum associated with another classic enteric duplication cyst in the adjacent bowel and presenting as an acute abdomen due to torsion of the pedicle of the CIDC. Cysts excision was curative.

Mucinous cystadenoma arising in an isolated ileal duplication cyst

INTRODUCTION

A 64-year-old woman with a 2-year history of bilateral breast carcinoma with axillary node metastasis and chemotherapy was admitted to our hospital due to tumor attached to the ileum, discovered during the routine control examination.

DISCUSSION

Computerized axial tomography showed oval cystic tumor in terminal ileum that measured 7 cm in the largest diameter and shared peritoneal coat with small intestine and was filled with dense fluid. Tumor abutted intestine but did not communicate with intestinal lumen. The surgical procedure was simple because cyst was attached to the antimesenteric side of the terminal ileum and did not communicate with the adjacent intestine. Pathohistological examination showed mucinous cystadenoma with high-grade epithelial dysplasia in the isolated ileal duplication cyst. The presence of epithelial dysplasia found in duplication cyst suggested potential to undergo malignant transformation.

CONCLUSION

In conclusion, we report a unique case of mucinous cystadenoma arising in isolated ileal duplication cyst. This case report expands the potential range of clinical variability of alimentary tract duplications. Surgical removal of alimentary tract duplication in patients without symptoms is also recommended because many potential complications or even malignant transformation may result from these anomalies.

Completely isolated alimentary tract duplication in a neonate

A rare case of a completely isolated, alimentary tract duplication cyst in a 27-day-old neonate is reported. The duplication cyst was detected on antenatal fetal ultrasound and magnetic resonance (MR) imaging at 27 weeks' gestational age. At surgery, the duplication cyst was in a retroperitoneal site with no apparent communication between the cyst and any portion of the alimentary tract. On histopathological examination, the diagnosis was a gastric duplication cyst. The patient's postoperative course was uneventful. There have been eight cases of completely isolated duplication reported in the literature, of which seven were detected during the prenatal or neonatal period. No previous report in the English literature has described the fetal MR imaging findings of this type of duplication cyst.

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

We present a case of omental pseudocyst associated with a perforated gastric duplication. A boy (2.5 years old) with an abdominal mass was admitted because thick-walled and thin-walled double cysts were identified on computed tomography and magnetic resonance imaging. At laparotomy, the double cysts were interconnected and located in the omentum with no communication to the stomach. Microscopic examination showed a thick-walled cyst composed solely of gastric tissue with muscle layers divided at the stricture between the 2 cysts and a thin-walled cyst without a true endothelial lining. Gastric duplications can be complicated with perforation and malignancy, and primary surgery is the first choice of treatment.

Prenatal diagnosis of an intrathoracic gastric duplication: a case report

We report an intrathoracic gastric duplication cyst detected antenatally on obstetrical ultrasonography at 33 weeks of gestation. After birth, the newborn was directly intubated. At day 19, the intrathoracic cyst was removed, and the patient discharged on his 27th day of life. Histologic findings confirmed the diagnosis of a gastric duplication cyst. This appears to be the first reported case of an intrathoracic gastric duplication detected antenatally. Intrathoracic gastric duplication should be among the differential diagnosis of any mediastinal cyst discovered antenatally; its detection allows appropriate management at birth.