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Takubo K, Shepherd NA. Normal embryology, foetal development and developmental abnormalities. MORSON AND DAWSON'S GASTROINTESTINAL PATHOLOGY 2024:13-20. [DOI: 10.1002/9781119423195.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Boicean A, Prisca D, Bratu DG, Bacila CI, Tanasescu C, Chicea R, Fleaca SR, Birsan SA, Ichim C, Mohor CI, Roman MD, Cristian AN, Todor SB, Mohor CI, Moisin A, Hasegan A. Uncommon Presentation of Gastric Duplication Cyst with Left-Sided Portal Hypertension: A Case Report and Literature Review. Diagnostics (Basel) 2024; 14:675. [PMID: 38611587 PMCID: PMC11011661 DOI: 10.3390/diagnostics14070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Gastric duplication cysts (GDCs) in adults are exceedingly rare, with only a few documented cases in medical literature. The spectrum of clinical presentations varies widely, ranging from asymptomatic to severe symptoms such as hematemesis, vomiting or abdominal pain. Among the less common complications associated with GDCs, segmental portal hypertension is a notable rarity. We present a compelling case report of a patient exhibiting signs of segmental portal hypertension, where ultrasound and echo-endoscopy revealed a sizable gastric duplication cyst as the underlying etiology. Recognizing the scarcity of literature on GDCs in adult patients, we conducted a thorough review to underscore the diagnostic significance of ultrasonography and endoscopic ultrasound (EUS) in accurately identifying these congenital anomalies. This case report and comprehensive literature review emphasize the pivotal role of EUS and abdominal ultrasound in achieving an accurate diagnosis of GDCs. By shedding light on the diagnostic and therapeutic intricacies, we aim to raise awareness among clinicians regarding this rare pathology and the importance of multimodal imaging approaches for optimal patient management.
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Affiliation(s)
- Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Diana Prisca
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Ciprian Ionut Bacila
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Ciprian Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Radu Chicea
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Sorin Radu Fleaca
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Sabrina Andreea Birsan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Calin Ilie Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Mihai Dan Roman
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Adrian Nicolae Cristian
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Andrei Moisin
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Adrian Hasegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
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Kim K, Kim J, Kim H. Case report: Surgical management of ileal duplication cyst in a cat: a case report and review of the literature. Front Vet Sci 2023; 10:1323088. [PMID: 38169649 PMCID: PMC10758454 DOI: 10.3389/fvets.2023.1323088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
A 6-year-old castrated, mixed breed cat presented with vomiting, anorexia, and lethargy. Ultrasonography and computed tomography revealed a round, well-marginated structure closely associated with the ileum proximal to the ileocolic junction. Exploratory laparotomy revealed a mass originating from the distal end of the ileum, close to the ileocolic junction. The mass did not interact with the intestinal lumen. Excisional biopsy with omentalization was performed without small intestinal resection to preserve the ileocolic junctions. Histopathological examination confirmed the presence of an enteric duplication cyst. The cat recovered uneventfully from surgery and remained asymptomatic postoperatively. No recurrence was identified 4 months after surgery. Enteric duplication cysts are uncommon congenital anomalies that originate in the gastrointestinal tract. They could either be communicating or non-communicating with the intestinal lumen. Enteric duplication cysts can be symptomatic or asymptomatic. Enteric duplication cysts associated with the esophagus, duodenum, and jejunum have also been reported in cats. However, to the best of our knowledge, this is the first reported case of an enteric duplication cyst in the feline ileum. Thus, enteric duplication should be considered a differential diagnosis in cystic masses of the ileum.
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Affiliation(s)
- Kihoon Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, Republic of Korea
| | - Hwiyool Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, Republic of Korea
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Yuan Z, Wei H, Zhang Y, Cao B, He B, Yuan H. Gastric duplication cysts: literature review and a case report of rare multiple gastric duplication cysts treated by endoscopic submucosal dissection. Postgrad Med 2023; 135:775-783. [PMID: 37877305 DOI: 10.1080/00325481.2023.2274308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
Gastric duplication cysts (GDCs) are rare structural abnormalities, especially in adults. We first report a rare case of small multiple GDCs in a woman, which presents as a submucosal tumor (SMT) at the gastric antrum. In consideration of the patient's request for surgical treatment and minimally invasive resection, endoscopic submucosal dissection (ESD) was performed to remove the cyst. The case provides a reference for ESD surgery to remove small GDCs. So far, there is no consensus or practice guidelines for the diagnosis and management of GDCs. Herein we perform a comprehensive literature review and discussion on GDCs. GDCs are 'repetitive' cystic or tubular structures of gastric mucosa and muscularis mucosae, and share the muscularis propria and serous layer with the normal gastric wall. GDCs protruding into the stomach cavity can be diagnosed by endoscopic ultrasound (EUS), which has higher specificity and accuracy than CT and MRI. Some GDCs may cause complications, even cancerization. Therefore, we suggest that once found, the GDCs could be completely resected. For GDCs protruding into the stomach cavity, endoscopic surgery such as ESD can be adopted to remove the lesion. Endoscopic full-thickness resection (EFTR) may become an option for larger GDCs in the future. For extraluminal GDC, laparoscopic surgery is currently preferred. In this review, we summarized the structural and histopathological characteristics of GDCs and various treatment therapies, in order to provide experience and reference for the diagnosis and treatment of GDCs in the future.
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Affiliation(s)
- Ziying Yuan
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hongyun Wei
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yuejuan Zhang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bin Cao
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Baoguo He
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hao Yuan
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Vasta G, Tursini S, Rovero E, Angotti R, Molinaro F, Briganti V. A case of double cystic esophageal duplication in VACTERL syndrome: the first case report and a review of the literature. Front Pediatr 2023; 11:1151039. [PMID: 37152324 PMCID: PMC10154566 DOI: 10.3389/fped.2023.1151039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/13/2023] [Indexed: 05/09/2023] Open
Abstract
Background An esophageal duplication cyst (EDC) is a rare malformation resulting from the embryonic foregut. VACTERL syndrome is a genetic disorder affecting many systems of the human body. We report the first case of VACTERL syndrome associated to asymptomatic double EDC. Case report A girl with anorectal malformation and rectovestibular fistula, kidney malformation, and various vertebral defects came to our attention at the time of birth. VACTERL disease was diagnosed. She underwent Peña anoplasty at 4 months of life without complications. MRI was conducted at the age of 2. It accidentally showed a double esophageal duplication (12 mm × 35 mm × 10 mm) at the D7-D9 level. We planned a thoracoscopy; previous intraoperative esophagogastroduodenoscopy showed an external compression of the native esophagus. Two duplicated esophageal lesions were removed. The patient made an uneventful recovery and was completely asymptomatic at long-term follow-up. Conclusions VACTERL syndrome is still a not well-defined disease. Based on the current literature, this is the first case of a double esophageal duplication in a patient affected by VACTERL syndrome. According to us, the thoracoscopic approach of esophageal duplications can be followed by experts. Complete surgical excision is possible even if the cyst shares a common muscular wall with the esophagus. For this reason, we suggest to close the muscular wall by a simple interrupted suture.
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Affiliation(s)
- G. Vasta
- Pediatric Surgery, San Camillo-Forlanini Hospital, Rome, Italy
- Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
- Correspondence: G. Vasta S. Tursini
| | - S. Tursini
- Pediatric Surgery, San Camillo-Forlanini Hospital, Rome, Italy
- Correspondence: G. Vasta S. Tursini
| | - E. Rovero
- Azienda Ospedaliera Universitaria Meyer, Firenze, Italy
| | - R. Angotti
- Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - F. Molinaro
- Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - V. Briganti
- Pediatric Surgery, San Camillo-Forlanini Hospital, Rome, Italy
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Gandhi D, Garg T, Shah J, Sawhney H, Crowder BJ, Nagar A. Gastrointestinal duplication cysts: what a radiologist needs to know. Abdom Radiol (NY) 2022; 47:13-27. [PMID: 34417830 DOI: 10.1007/s00261-021-03239-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022]
Abstract
Gastrointestinal tract duplication cysts are rare congenital malformations which can be diagnosed as early as the prenatal period but are frequently found in infancy or incidentally in adulthood. They can be seen throughout the alimentary tract with the most common involving the distal ileum and second most common the esophagus. Many duplication cysts are asymptomatic and thus discovered as an incidental imaging finding, though they can also be symptomatic with an array of clinical presentations dependent largely on their location. The vast majority of duplication cysts are benign; however, there are rare instances of malignant transformation reported. The aim of this review is to show how multimodality imaging can help in the diagnosis of duplication cysts at various anatomical locations. Duplication cyst can become symptomatic and in rare cases undergo malignant transformation; therefore, they are typically managed with surgical excision, particularly if found prenatally or during infancy. Given the diversity of anatomic locations, multiple differential diagnoses, and the need for surgical intervention, it is valuable to comprehend the role of multimodality imaging role in diagnosing duplication cysts.
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Affiliation(s)
- Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL, 60611, USA.
| | - Tushar Garg
- Department of Radiology, Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel East, Parel, Mumbai, Maharashtra, 400012, India
| | - Jignesh Shah
- Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, TN, 38103, USA
| | - Harpreet Sawhney
- Department of Radiology, Bridgeport Hospital at Yale New Haven Health, 167 Grant St, Bridgeport, CT, 06610, USA
| | - Benjamin James Crowder
- Department of Radiology, The Ohio State University Wexner Medical Center, 395W, 12th Av, 4th Floor, Columbus, OH, 43210, USA
| | - Arpit Nagar
- Department of Radiology, The Ohio State University Wexner Medical Center, 395W, 12th Av, 4th Floor, Columbus, OH, 43210, USA
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Erosive effects of a posterior mediastinal mass in a 18th to early 19th c. Spanish child mummy. Forensic Sci Med Pathol 2018; 14:574-578. [PMID: 30145698 DOI: 10.1007/s12024-018-0013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 12/15/2022]
Abstract
During the 2011 restoration works in the central nave of the church of the Assumption of Our Lady, known as "The Piquete", in the village of Quinto (about 50 kms southwest of Zaragoza, Spain), the remains of 70 individuals were uncovered. Of these there were 32 mummified bodies, four of which have been investigated with CT scans. Here we report on the findings in one such individual, namely a child of between 7 and 8 years of age, whose sex is debatable but may well be female. The main pathological finding is the presence of pressure erosion and distortion of the upper thoracic spine, the cause of which is discussed with the conclusion that this may well represent a neurenteric duplication cyst. The possible consequences of such a lesion are considered.
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Salam A, Mubashir M, Mubashir H, Fatimi SH. Giant retrocardiac foregut duplication cyst presenting with left atrial compression and palpitations. BMJ Case Rep 2017; 2017:bcr-2017-222427. [PMID: 29237664 DOI: 10.1136/bcr-2017-222427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old man presented with a 3-month history of palpitations and shortness of breath. An ECG showed premature atrial contractions and episodes of supraventricular tachycardia. A subsequent echocardiogram showed a retrocardiac cystic mass that was compressing the left atrium. A CT scan confirmed these findings by showing a large left-sided posterior mediastinal cyst compressing the left atrium and pulmonary veins. The cyst was successfully excised from the retrocardiac position via left thoracotomy after which there was complete resolution of the palpitations. Histopathology showed it to be a mediastinal cyst, most likely a foregut duplication of the enterogenic variant. This is an extremely unusual case of foregut duplication cyst presenting with compression of the left atrium and pulmonary veins leading to atrial arrhythmias.
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Affiliation(s)
- Abdus Salam
- Medical College, Aga Khan University, Karachi, Pakistan
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Han IS, Kim GH, Lee SJ, Lee BE, I H, Kim YD. [A Case of Hemorrhage of an Esophageal Duplication Cyst Improved by Endoscopic Drainage]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2017; 69:363-367. [PMID: 28637106 DOI: 10.4166/kjg.2017.69.6.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Esophageal duplication cyst is a rare congenital gastrointestinal malformation. It is the second most common duplication cyst following small bowel duplication cyst in the gastrointestinal tract. Patients with an esophageal duplication cyst are generally asymptomatic; however, some patients may present the following symptoms: dysphagia, chest pain, stridor, unproductive cough, and epigastric discomfort by compression of the surrounding structures. Surgical removal is the treatment of choice in symptomatic cases and can be considered in asymptomatic cases if they are at risk for developing complications, such as ulceration or perforation. Herein, we report a case of hemorrhage of an esophageal duplication cyst, which was improved by endoscopic drainage.
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Affiliation(s)
- In Sub Han
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seong Jun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea
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The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc 2017; 85:1117-1132. [PMID: 28385194 DOI: 10.1016/j.gie.2017.02.022] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
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Valli PV, Gubler C, Bauerfeind P. Severe Infectious Complications after Endoscopic Ultrasound-Guided Fine Needle Aspiration of Suspected Mediastinal Duplication Cysts: A Case Series. Inflamm Intest Dis 2017; 1:165-171. [PMID: 29922673 DOI: 10.1159/000464327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/19/2017] [Indexed: 01/19/2023] Open
Abstract
Background and Study Aims The role of cyst cytology to diagnose mediastinal duplication cysts remains controversial. Since endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of duplication cysts has been considered as safe so far, there are only a few case reports of infections following FNA. Case Summary We report a case series of all patients at our institution undergoing EUS evaluation for suspected mediastinal duplication cysts (n = 5) in the last 15 years. The mediastinal lesion in 4 patients did not feature typical EUS features for duplication cysts, wherefore we did perform EUS-guided FNA in order to rule out malignancy. In 3 out of 4 patients, a duplication cyst was confirmed. The fourth lesion turned out to be a sarcoma. All 4 patients developed severe FNA-induced cyst infection causing mediastinitis and the need for surgical debridement. Despite an immediate review of the FNA by the on-site cytopathologist with establishing the diagnosis of a duplication cyst, peri-interventional broad-spectrum antibiotics could not prevent severe infections of the lesions. Conclusions Given the potentially high rate of infectious complications, we advocate a very restrictive indication for diagnostic FNA in mediastinal masses. Yet, in unclear cases, FNA might be indispensable despite the potential adverse events in order to rule out hypoechogenic, mediastinal malignancy.
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Affiliation(s)
- Piero V Valli
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
| | - Christoph Gubler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
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Yüksel M, Kacar S, Akpinar MY, Saygili F, Akdoğan Kayhan M, Dişibeyaz S, Özin Y, Kaplan M, Ateş İ, Kayaçetin E. Endosonogragphic features of lesions suggesting gastricectopic pancreas: experience of a single tertiary center. Turk J Med Sci 2017; 47:313-317. [PMID: 28263508 DOI: 10.3906/sag-1602-181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/30/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM We aimed to present the endoscopic ultrasound (EUS) features of gastric lesions suggesting gastric ectopic pancreas during upper gastrointestinal endoscopy that were diagnosed in our gastroenterology unit, which is a tertiary center for endoscopic procedures in Turkey. MATERIALS AND METHODS The data of patients who underwent upper gastrointestinal EUS in our center between April 2012 and July 2014 were retrospectively analyzed. RESULTS All of the lesions suggesting gastric ectopic pancreas were localized in the gastric antrum. Thirty-six of 44 lesions (81.1%) showed central dimpling. Lesion borders were shown to be definite in 10 (22.7%) lesions, whereas the borders of 34 lesions (77.3%) were indefinite. Thirty-nine lesions (88.6%) had heterogeneous and 5 lesions (11.4%) had homogeneous echo patterns; whereas 29 lesions (65.9%) were hypoechoic, 9 lesions (20.5%) were hyperechoic and 6 lesions (13.6%) had mixed echogenicity. Forty-two lesions (95.5%) were shown to affect only a single sonographic layer of the gastric wall. CONCLUSION EUS features of lesions that strongly suggest gastric ectopic pancreas endoscopically, without any histopathological evidence and without either endoscopic or surgical resection, are as follows: indefinite border appearance, minimal heterogeneous hypoisoechoic echo pattern, existence of anechoic duct-like structures inside the lesion, common localization in the submucosal layer, and existence of umbilication.
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Affiliation(s)
- Mahmut Yüksel
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Sabite Kacar
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Muhammet Yener Akpinar
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Fatih Saygili
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Meral Akdoğan Kayhan
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Selçuk Dişibeyaz
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Yasemin Özin
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Mustafa Kaplan
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - İhsan Ateş
- Department of Internal Medicine, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ertuğrul Kayaçetin
- Department of Gastroenterology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
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Thomopoulos T, Farin C, Navez B. Total Laparoscopic Treatment of an Adult Gastric Duplication Cyst with Intrapancreatic Extension. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:352-6. [PMID: 27221785 PMCID: PMC4913731 DOI: 10.12659/ajcr.897642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patient: Female, 28 Final Diagnosis: Gastric duplication Symptoms: — Medication: — Clinical Procedure: Resection of the duplication Specialty: Surgery
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Affiliation(s)
- Theodoros Thomopoulos
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Coppelia Farin
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Benoit Navez
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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14
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Gjeorgjievski M, Manickam P, Ghaith G, Cappell MS. Safety and Efficacy of Endoscopic Therapy for Nonmalignant Duodenal Duplication Cysts: Case Report and Comprehensive Review of 28 Cases Reported in the Literature. Medicine (Baltimore) 2016; 95:e3799. [PMID: 27258515 PMCID: PMC4900723 DOI: 10.1097/md.0000000000003799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/20/2016] [Accepted: 05/02/2016] [Indexed: 12/28/2022] Open
Abstract
Analyze efficacy, safety of endoscopic therapy for duodenal duplication cysts (DDC) by comprehensively reviewing case reports.Tandem, independent, systematic, computerized, literature searches were performed via PubMed using medical subject headings or Keywords "cyst" and "duodenal" and "duplication"; or "cyst", and "endoscopy" or "endoscopic", and "therapy" or "decompression"; with reconciliation of generated references by two experts. Case report followed CARE guidelines.Literature review revealed 28 cases (mean = 1.3 ± 1.2 cases/report). Endoscopic therapy is increasingly reported recently (1984-1999: 3 cases, 2000-2015: 25 cases, P = 0.003, OR = 8.33, 95%-CI: 1.77-44.5). Fourteen (54%) of 26 patients were men (unknown-sex = 2). Mean age = 32.2 ± 18.3 years old. Procedure indications: acute pancreatitis-16, abdominal pain-8, jaundice-2, gastrointestinal (GI) obstruction-1, asymptomatic cyst-1. Mean maximal DDC dimension = 3.20 ± 1.53 cm (range, 1-6.5 cm). Endoscopic techniques included cyst puncture via needle knife papillotomy (NKP)/papillotome-18, snare resection of cyst-7, cystotome-2, and cyst needle aspiration/ligation-1. Endoscopic therapy was successful in all cases. Among 24 initially symptomatic patients, all remained asymptomatic post-therapy without relapses (mean follow-up = 36.5 ± 48.6 months, 3 others reported asymptomatic at follow-up of unknown duration; 1 initially asymptomatic patient remained asymptomatic 3 years post-therapy). Two complications occurred: mild intraprocedural duodenal bleeding related to NKP and treated locally endoscopically.A patient is reported who presented with vomiting, 15-kg-weight-loss, and profound dehydration for 1 month from extrinsic compression of duodenum by 14 × 6 cm DDC, underwent successful endosonographic cyst decompression with large fenestration of cyst and endoscopic aspiration of 1 L of fluid from cyst with rapid relief of symptoms. At endoscopy the DDC was intubated and visualized and random endoscopic mucosal biopsies were obtained to help exclude malignant or dysplastic DDC.Study limitations include retrospective literature review, potential reporting bias, limited patient number, variable follow-up.In conclusion, endoscopic therapy for DDC was efficacious in all 29 reported patients including current case, including patients presenting acutely with acute pancreatitis, or GI obstruction. Complications were rare and minor, suggesting that endoscopic therapy may be a useful alternative to surgery for nonmalignant DDC when performed by expert endoscopists.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- From the Division of Gastroenterology & Hepatology, William Beaumont Hospital (MG, PM, GG, MSC); and Oakland University William Beaumont School of Medicine (GG, MSC), Royal Oak, MI
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15
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Affiliation(s)
- Eugene P DiMagno
- Mayo Medical School and Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. .,, 630 Memorial Parkway SW, Rochester, MN, 55902, USA.
| | - Matthew J DiMagno
- University of Michigan School of Medicine and Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1150 W Medical Center Drive, 6520 MSRB 1, Ann Arbor, MI, 48109, USA
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16
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Machado MA, Makdissi FF, Surjan RC. Single-port for laparoscopic gastric resection with a novel platform. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:157-9. [PMID: 25004297 PMCID: PMC4678675 DOI: 10.1590/s0102-67202014000200015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/13/2014] [Indexed: 12/21/2022]
Abstract
Introduction Laparoscopic gastrointestinal resections using single-port are possible, but
triangulation problems and the need of articulated instruments difficult the
procedures. Aim To present a surgical alternative using single-port laparoscopic device on gastric
resection. Technique The patient is placed in a supine and reverse Trendelenburg position with surgeon
between patient's legs. First assistant was on the right side of the patient with
the monitor placed on the patient's cranial side. With the patient under general
anesthesia, a transumbilical 3 cm skin incision is performed. A single-incision
advanced access platform with gelatin cap, self-retaining sleeve and wound
protector is introduced through this incision. Three 5-12 mm operating ports were
introduced through the single-port device. Due to the gel cap and sleeves, no
articulated instruments are necessary. CO2 pneumoperitoneum is
established at 12 mmHg. A rigid 30 degree 10 mm laparoscope is introduced.
Operation begins with access to the lesser sac by opening the omentum along the
greater curvature of the stomach using harmonic scalpel. Once the stomach is fully
exposed and a stay suture is place around the tumor. Gastric wall is divided with
cautery 1 cm away from the tumor. Tumor is excised. Gastric wall is sutured with
two-layer running suture. No drain was used. Umbilical incision was closed. Results This procedure was used in one patient with gastric duplication. Operative time
was 200 minutes. Blood loss was minimal. Recovery was uneventful and patient
discharged on postoperative day 2. Final aspect of the umbilical incision was
good. Conclusions Gastric resection with single-port laparoscopic platform is feasible and may be
safely performed in selected patients.
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17
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Yazici MU, Ekinci S, Turkmen OK, Yalcin EG, Ciftci AO, Gucer S, Orhan D, Tezcan I. Recurrent hemoptysis and a mass in the thorax in an infant: the split notochord syndrome. European J Pediatr Surg Rep 2015; 2:38-42. [PMID: 25755968 PMCID: PMC4335950 DOI: 10.1055/s-0033-1354745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022] Open
Abstract
Split notochord syndrome is a rare group of developmental abnormalities caused by abnormal splitting or deviation of the notochord clinically resulting in the duplicated bowel associated with vertebral anomalies. We report on a case of 11-month-old female infant with mediastinal hyperechogenic cyst and intestinal duplication cyst associated with T5-T6 hemivertebrae, scoliosis, and nonfusion of posterior part of T6 vertebrae, presenting with severe hemoptysis and hematemesis. The cysts were surgically removed, and histopathologic analysis revealed that the mediastinal cyst was lined by gastric mucosa and intestinal one was lined with gastric mucosa including ectopic pancreatic tissue. After removal of the lesion the patient made an uneventful recovery and shows no signs of long-term pulmonary sequelae.
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Affiliation(s)
- Mutlu Uysal Yazici
- Department of Pediatrics, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Ozlem Keskin Turkmen
- Department of Pediatric Allergy and Immunology, Gaziantep University, Ankara, Turkey
| | - Ebru Gunes Yalcin
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Arbay O Ciftci
- Department of Pediatric Surgery, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Safak Gucer
- Department of Pediatric Pathology, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University, Ankara, Turkey
| | - Ilhan Tezcan
- Department of Pediatric Immunology, Hacettepe University School of Medicine, Ankara, Turkey
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18
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Liu R, Adler DG. Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound. Endosc Ultrasound 2014; 3:152-60. [PMID: 25184121 PMCID: PMC4145475 DOI: 10.4103/2303-9027.138783] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/29/2014] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts. Endoscopic ultrasound (EUS) has been widely used as a modality for the evaluation and diagnosis of duplication cysts. EUS is the diagnostic tool of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. The question of whether or not to perform EUS-fine needle aspiration (EUS-FNA) on a lesion suspected of being a duplication cyst is controversial as these lesions can become infected with significant consequences, although EUS-FNA is often required to obtain a definitive diagnosis and to rule out more ominous lesions. This manuscript will review the literature on duplication cysts throughout the body and will also focus on the role of EUS and FNA with regards to these lesions.
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Affiliation(s)
- Roy Liu
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
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19
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Dinneen HS, Protopapas G, Peters SR, Ahlawat S. Gastric duplication cyst presenting as acquired pyloric stenosis. Gastrointest Endosc 2014; 80:194-5. [PMID: 24950655 DOI: 10.1016/j.gie.2014.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Henry S Dinneen
- Internal Medicine Department, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - George Protopapas
- Gastroenterology and Hepatology Department, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Stephen R Peters
- Pathology Department, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sushil Ahlawat
- Gastroenterology and Hepatology Department, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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20
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Importance of the ultrasonography in diagnosis of ileal duplication cyst. Gastroenterol Res Pract 2013; 2013:248625. [PMID: 24302931 PMCID: PMC3835361 DOI: 10.1155/2013/248625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal duplication cysts are rare congenital anomalies that can be seen in anywhere of the gastrointestinal system from the mouth to the anus. These are prenatally diagnosed through antenatal ultrasonography. However, attention must be paid since these formations might be confused with ovarian or mesenteric cysts. Our patient, who had been diagnosed with ovarian cyst on the ultrasonography performed in another center and with mesenteric cyst based on the abdominal MRI carried out at fifth month of life, presented to our clinic with the only complaint of constipation at 9th month of life. The diagnosis was set through double wall appearance of duplication cyst on the abdominal ultrasonography. The patient's cyst was resected.
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21
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Shin SK, Chung JW, Lee JH, Kim YJ, Kwon KA, Park DK, Lee WK. Prevalence and Predictive Factors of Malignant Potential in Resected Gastric Subepithelial Tumors. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2013. [DOI: 10.7704/kjhugr.2013.13.2.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun-Won Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jung Hyun Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yoon Jae Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang Ahn Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Kyun Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Woon Kee Lee
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Rangasami R, Chandrasekharan A, Archana L, Santhosh J. Case report: Antenatal MRI diagnosis of esophageal duplication cyst. Indian J Radiol Imaging 2011; 19:75-7. [PMID: 19774145 PMCID: PMC2747414 DOI: 10.4103/0971-3026.45350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Esophageal duplication cysts are classified as a subgroup of foregut duplication cysts. They are very rare and are predominantly detected in children. Antenatal detection is very rare. We report a case of an esophageal duplication cyst that was accurately identified antenatally by USG and MRI.
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23
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Folkers ME, Adler DG. Endoscopic ultrasound for non-gastroenterologists: what you need to know. Hosp Pract (1995) 2011; 39:56-69. [PMID: 21576898 DOI: 10.3810/hp.2011.04.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Endoscopic ultrasound (EUS) combines the use of flexible fiberoptic endoscopes with high-resolution ultrasound technology. It is increasingly used for the evaluation, staging, and diagnosis of many luminal and extraluminal gastrointestinal (GI) cancers, as well as non-GI tract ailments, including the staging of lung cancer. In the past decade, EUS has become available on a wide scale, with an increasing number of indications. The technology has been shown to be comparable with and often more sensitive than computed tomography scan and magnetic resonance imaging in staging many malignancies. The use of fine-needle aspiration and ultrasound-guided injection also allows for accurate tissue diagnosis and therapy of GI ailments. Despite increasing availability and indications for EUS over the past decade, general internists may not be aware of EUS technology, when to order an EUS, and how to integrate the results of an EUS into their management decisions. This article will review the general indications for EUS referral, limitations, and role of EUS in the practice of general medicine.
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Affiliation(s)
- Milan E Folkers
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, UT 84312, USA
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24
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Infectious Risk Enhanced Because of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration of Bronchogenic Cysts. J Bronchology Interv Pulmonol 2010; 17:283-4. [DOI: 10.1097/lbr.0b013e3181ead75c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W. Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc 2010; 71:722-7. [PMID: 20171632 DOI: 10.1016/j.gie.2009.10.019] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 10/08/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS combined with endoluminal resection techniques is increasingly used to provide a definitive diagnosis of small gastric subepithelial lesions seen on standard upper endoscopy. OBJECTIVE To evaluate the accuracy of EUS in diagnosing small gastric subepithelial lesions by using histology as the criterion standard. DESIGN A retrospective study. SETTING Academic tertiary care center. PATIENTS A total of 22 patients (15 women, mean age 62.2 years) with an endoscopically resected gastric subepithelial lesion were included in this 3-year retrospective study. MAIN OUTCOME MEASUREMENTS The size, echogenicity, the layer of origin, and presumptive diagnosis were determined by EUS. The diagnostic accuracy of EUS was determined by using histology as the criterion standard. RESULTS The mean size of the 22 lesions was 13.6 mm (range 8-20 mm). An endoscopic cap band mucosectomy device was used to resect 16 (72.7%) lesions, whereas 6 (27.3%) were resected with a saline solution-assisted and snare technique. Using histology as a criterion standard, we found that the accuracy of the EUS diagnosis was 10 of 22 (45.5%). EUS alone had an accuracy rate of 30.8% and 66.7%, respectively, in the diagnosis of neoplastic and non-neoplastic lesions. LIMITATIONS A single-center, retrospective analysis. CONCLUSION EUS imaging had a low accuracy rate in the diagnosis of gastric subepithelial lesions, and endoscopic submucosal resection should be performed to provide a histologic diagnosis. Resection of small subepithelial lesions of 20 mm or less can be accomplished en bloc with an endoscopic cap band mucosectomy device.
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Affiliation(s)
- Cetin Karaca
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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26
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Sarkar M, Wood R, Oh Y, Hecht TEH, Kaiser L, Wasserstein A, Kochman ML. Presentation and management of acute fistulization of a foregut duplication cyst. Gastrointest Endosc 2008; 68:804-6. [PMID: 18436220 DOI: 10.1016/j.gie.2007.12.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 12/31/2007] [Indexed: 02/08/2023]
Affiliation(s)
- Monika Sarkar
- Department of Medicine, Gastroenterology Division, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104-4283, USA
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27
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Chen SH, Huang WH, Feng CL, Chou JW, Hsu CH, Peng CY, Yang MD. Clinical analysis of ectopic pancreas with endoscopic ultrasonography: an experience in a medical center. J Gastrointest Surg 2008; 12:877-81. [PMID: 18246404 DOI: 10.1007/s11605-008-0476-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 01/09/2008] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the endosonographic features of gastrointestinal ectopic pancreas, especially when histopathological diagnosis is unachievable with nonsurgical modalities. METHODS Endoscopic ultrasonography was performed in 20 patients with endoscopically recognized ectopic pancreas. We then analyzed the endosonographic features of the lesions and the clinical aspects of the patients, including age, gender, symptoms, and lesion locations. RESULTS Endoscopic ultrasonography revealed that the lesions originated from the second, third, and/or fourth layers of the gastrointestinal wall. Most lesions (95%, 19/20) were heterogenous, mainly hypoechoic or mixed, in echogenicity. The borders of the lesions were indistinct in 13 (13/20, 65%) and distinct in 7 (7/20, 35%) patients. Anechoic cystic or tubular structures within the lesions appeared in 7 of the 20 lesions (35%). CONCLUSION Ectopic pancreas usually appears as a submucosal lesion with characteristic central dimpling. Furthermore, characteristic endoscopic ultrasonographic features can readily assist in the diagnosis of ectopic pancreas without having to perform endoscopic biopsy or surgery. However, either endoscopic ultrasonography-guided fine needle aspiration or endoscopic removal of lesions should still be considered mandatory for the differential diagnosis of ectopic pancreas whenever typical endosonographic features cannot be well demonstrated.
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Affiliation(s)
- Sheng-Hung Chen
- Division of Gastroenterology, Department of Internal Medicine, China Medical University Hospital, 2 Yuh-Der Road, North District, Taichung 40447, Taiwan, Republic of China
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Abstract
BACKGROUND Endoscopic ultrasound is a diagnostic tool for evaluation of gastrointestinal diseases in adults, but in children the use of endoscopic ultrasound is limited. This study retrospectively evaluates endoscopic ultrasound indications in, safety in, and impact on children. PATIENTS AND METHODS We reviewed the data of all of the pediatric patients (<18 years old) that underwent endoscopic ultrasound in our institution. The main goal was to evaluate the impact of endoscopic ultrasound in this patient population. Significant impact was defined as a new diagnosis or treatment attributed to the endoscopic ultrasound examination. RESULTS Thirty-two children (21 boys, 11 girls) at mean age 12 +/- 5 years; (range = 1.5-18 years) underwent endoscopic ultrasound during a period of 6 years. The pancreas and biliary tract were examined in 19 children, esophagus in 8, and the stomach and rectum in 2 children each. Only 1 child had endoscopic ultrasound for duodenal indication. The indications in the pancreas and biliary tract group were recurrent pancreatitis in 9 children, cyst or mass in 6 children, and obstructive jaundice in 4 children. Indications in the esophagus group were stenosis in 4 children, and suspected duplication and esophageal mass in 2 children each. We used conscious sedation in 18 children and unconscious sedation in 12. Two children underwent endoscopic ultrasound with no anesthesia at all. In 7 cases, endoscopic ultrasound-guided fine-needle aspiration was performed. The procedure was successful in all of the patients with no complications. Endoscopic ultrasound changed the diagnosis or therapy in 14 cases. CONCLUSIONS Endoscopic ultrasound is an effective tool in the evaluation of pediatric gastrointestinal patients, mostly with pancreatobiliary or esophageal disorders. Endoscopic ultrasound is a safe procedure with a significant impact in almost half of the children examined.
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Abstract
The finding of a mass lesion in the upper gastrointestinal tract at endoscopy with apparent normal overlying mucosa is common. The differential diagnosis of such lesions is broad and includes those of intramural or extramural origin. Endoscopic ultrasound provides accurate imaging of subepithelial mass lesions and characterizes them according to size, echogenicity, and origin including the histologic layer if the lesion is intramural which narrows the differential diagnosis. Endoscopic ultrasound allows a guided tissue sample to be obtained for histologic confirmation which is especially important for hypoechoic lesions arising from the 3rd or 4th echogenic layers. The purpose of this article is to review the diagnosis of the more common subepithelial mass lesions with an emphasis on endoscopic ultrasound and the subsequent management or monitoring.
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Affiliation(s)
- Jeremy L Humphris
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, and University of Sydney, Sydney, New South Wales, Australia
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30
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Grover M, Gupta A, Wagner DP, Orringer MB. Hard to swallow. Am J Med 2007; 120:1023-5. [PMID: 18060919 DOI: 10.1016/j.amjmed.2007.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 08/29/2007] [Accepted: 08/30/2007] [Indexed: 11/26/2022]
Affiliation(s)
- Madhusudan Grover
- Department of Internal Medicine, Michigan State University, East Lansing, Mich 48842, USA.
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31
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Abstract
A 39 year-old male was admitted to our hospital because of relapsing episodes of pneumonia. His chest roentgenogram showed a consolidated shadow and cavity formation in the left lower lobe. During a left lower lobectomy an enteric cyst in the posterior mediastinum involving lung was found. This cyst in the lung contained normal gastric parietal cells and pancreatic tissue, and was surrounded by adenocarcinoma characteristic of gastric cancer. This is a rare case in which an adenocarcinoma arise from an enteric cyst in the mediastinum.
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Affiliation(s)
- Keiko Suzuki
- Division of General Medicine, Clinical Department of Internal Medicine, Jichi Medical University Omiya Medical Center, Saitama.
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32
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Hirose S, Clifton MS, Bratton B, Harrison MR, Farmer DL, Nobuhara KK, Lee H. Thoracoscopic Resection of Foregut Duplication Cysts. J Laparoendosc Adv Surg Tech A 2006; 16:526-9. [PMID: 17004883 DOI: 10.1089/lap.2006.16.526] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Foregut duplications are rare entities that include both esophageal and bronchogenic cysts. The diagnosis of foregut duplication cyst is made most often from an incidental finding on chest radiograph, or due to respiratory compromise due to mass effect or infection. Treatment consists of complete resection. Recurrences are associated with incomplete resection. Six cases of foregut duplication cysts are presented that were resected thoracoscopically. MATERIALS AND METHODS From May 1998 to April 2003, six patients underwent thoracoscopy for resection of foregut duplication cyst. One patient required conversion to open thoracotomy due to esophageal perforation. The distribution of cysts was 4 on the left and 2 on the right; all procedures were performed with three or four ports. Single lung ventilation was used in three patients. The masses were removed via a port site after intrathoracic decompression. Chest tubes were placed in all patients, and most were removed within 12 hours. RESULTS Five of six cases underwent successful thoracoscopic resection. Pathology demonstrated esophageal duplication cyst in three patients and bronchogenic cyst in the other three patients. Average hospital stay was 5.5 days. Complications included aspiration pneumonia and chest tube dislodgment. There were no deaths, and no recurrences. CONCLUSION Thoracoscopic resection is a safe and effective method of treating foregut duplications. Outcomes have been good with little short-term morbidity and no mortality. Morbidity and cosmesis are improved by avoiding thoracotomy. Thoracoscopic resection should be considered the first-line therapy for these benign masses.
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Affiliation(s)
- Shinjiro Hirose
- Department of Surgery, University of California, San Francisco, California 94143-0570, USA
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33
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Joyce AM, Zhang PJ, Kochman ML. Complete endoscopic resection of an esophageal duplication cyst (with video). Gastrointest Endosc 2006; 64:288-9. [PMID: 16860091 DOI: 10.1016/j.gie.2006.04.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 04/11/2006] [Indexed: 12/10/2022]
Affiliation(s)
- Ann Marie Joyce
- Gastroenterology Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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34
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Hwang JH, Rulyak SD, Kimmey MB. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 2006; 130:2217-28. [PMID: 16762644 DOI: 10.1053/j.gastro.2006.04.033] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This literature review and the recommendations therein were prepared for the American Gastroenterological Association Institute Clinical Practice and Economics Committee. The paper was approved by the Committee on January 19, 2006, and by the AGA Institute Governing Board on April 20, 2006.
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Affiliation(s)
- Joo Ha Hwang
- Division of Gastroenterology, University of Washington, Seattle, Washington, USA
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Radlinsky MAG, Biller DS, Nietfeld J, Enwiller T. Subclinical intestinal duplication in a cat. J Feline Med Surg 2005; 7:223-6. [PMID: 16055007 PMCID: PMC10822327 DOI: 10.1016/j.jfms.2004.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 09/29/2004] [Indexed: 11/24/2022]
Abstract
An abdominal mass was identified upon palpation of the abdomen in a normal, asymptomatic, 1-year-old female domestic shorthair cat presented for elective ovariohysterectomy. Radiographic and ultrasound examinations demonstrated a well-circumscribed caudal abdominal mass. Ultrasound guided needle aspiration cytology was consistent with an accumulation of squamous epithelial cells. The mass was associated with the jejunum and was excised via resection anastomosis of the intestinal segment after ovariohysterectomy. Histologic examination provided the diagnosis of an intestinal duplication lined with epithelium typical of that in the esophagus. The cat recovered without complications.
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Affiliation(s)
- Mary Ann G Radlinsky
- Kansas State University, Department of Clinical Sciences, College of Veterinary Medicine, 1800 Denison Avenue, Manhattan, KS 66506-5606, USA.
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Abstract
Most of the submucosal lesions encountered on endoscopy are benign; however, the fact that some of them may be malignant considerably influences the attitude toward the whole group. This article reviews the current status of endosonography in the management of submucosal lesions and focuses on determining the risk of malignancy. The predictive value of various endoscopic ultrasonography (EUS) features and their combinations and the capabilities and limitations of EUS-guided fine needle biopsy are discussed. Other issues addressed include differentiation between extraluminal compressions and true submucosal lesions, EUS-assisted endoscopic removal of submucosal lesions, and the potential role of catheter-based endosonography in the setting of submucosal lesions. Problems related to the surveillance of patients with submucosal lesions who are not candidates for surgical treatment are outlined. An overview of the recent changes in the pathologic classification of gastrointestinal mesenchymal tumors and their impact on the role of EUS in the management of submucosal lesions is given.
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Affiliation(s)
- Marcin Polkowski
- Department of Gastroenterology, Medical Center for Postgraduate Education, Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland.
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Eloubeidi MA, Cohn M, Cerfolio RJ, Chhieng DC, Jhala N, Jhala D, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of foregut duplication cysts: the value of demonstrating detached ciliary tufts in cyst fluid. Cancer 2004; 102:253-8. [PMID: 15368318 DOI: 10.1002/cncr.20369] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The management of foregut duplication cysts is controversial, especially in asymptomatic patients. The safety and accuracy of endoscopic ultrasound (EUS) and EUS-fine-needle aspiration EUS-FNA) in confirming the nature of cysts by using electron microscopy (EM) has not been reported. In this study, the authors describe the utility of demonstrating detached ciliary tufts (DCTs) in the diagnosis of foregut duplication cysts with EUS-FNA. METHODS Consecutive patients with suspected mediastinal masses or mediastinal cysts on imaging studies were evaluated prospectively by EUS and EUS-FNA. Cyst fluid was examined by routine cytologic techniques. In two patients, EM was performed to confirm the nature of DCTs. RESULTS Ten consecutive patients were evaluated with EUS and EUS-FNA. Seventy percent of the cysts were characterized by computed tomography (CT) scans as solid masses. The mean greatest cyst dimension measured 34 mm x 48 mm by EUS. Microscopic examination of the cyst content revealed mucinous material, cellular debris, and DCTs. The latter were seen in routine cytologic preparations and by EM. Patients were followed up to a median of 321 days. Due to EUS-FNA confirmatory diagnoses of foregut duplication cysts, none of the patients except 1 underwent surgical resection after developing pneumonia 6 months later. Histologic sections of the resected specimen confirmed the presence of (foregut cyst, bronchogenic type). All other patients were asymptomatic. Cysts size and nature did not change on repeated imaging studies. CONCLUSIONS EUS was superior compared with CT scanning in characterizing foregut duplication cysts. EUS-FNA is safe and accurate in the diagnosis of foregut duplication cysts. The demonstration of DCTs in cyst fluid and the absence of malignant cells confirmed the benign nature of these lesions, allowing conservative and expectant management for these patients.
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Affiliation(s)
- Mohamad A Eloubeidi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama-Birmingham, Birmingham, Alabama 35294-0007, USA.
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Lee LS, Singhal S, Brinster CJ, Marshall B, Kochman ML, Kaiser LR, Kucharczuk JC. Current management of esophageal leiomyoma. J Am Coll Surg 2004; 198:136-46. [PMID: 14698321 DOI: 10.1016/j.jamcollsurg.2003.08.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Lawrence S Lee
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Abstract
Foregut duplication cysts are rare congenital anomalies of enteric origin. In majority of the patients, the diagnosis is made in infancy. The authors report 4 cases of mediastinal foregut duplication cyst in children diagnosed on CT/MRI and confirmed on histopathology. In none of the cases the cysts had intraspinal extension nor heterotopic gastric mucosa.
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Affiliation(s)
- Kamal Nain Rattan
- Department of Pediatric Surgery, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Affiliation(s)
- Joo Ha Hwang
- Division of Gastroenterology, University of Washington, Seattle, Washington 98195, USA
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Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation. Gastrointest Endosc 2003. [PMID: 12665764 DOI: 10.1067/s0016-5107(03)00009-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although endoscopic papillary balloon dilation may result in acute pancreatitis or hyperamylasemia, the risk factors for these complications have not been well documented. Risk factors predictive of acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation were retrospectively analyzed. METHODS In 118 patients who underwent endoscopic papillary balloon dilation for choledocholithiasis, postendoscopic papillary balloon dilation acute pancreatitis and hyperamylasemia (at least 3-fold elevation) were investigated. A multivariate analysis was conducted for 20 potential risk factors related to clinical and procedure characteristics. RESULTS Bile duct clearance was achieved in 113 patients. Early complications in the form of mild pancreatitis occurred in 7 patients (6%). Multivariate analysis identified history of acute pancreatitis as the only risk factor for postendoscopic papillary balloon dilation pancreatitis. Postendoscopic papillary balloon dilation hyperamylasemia occurred in 30 patients (25%). Multivariate analysis identified 4 independent risk factors for hyperamylasemia: an age of 60 years or less, previous pancreatitis, bile duct diameter 9 mm or less, and difficult bile duct cannulation. CONCLUSIONS Endoscopic papillary balloon dilation is associated with a relatively low occurrence (6%) of pancreatitis but a high frequency (25%) of hyperamylasemia. The latter may represent pancreatic irritation or latent pancreatic injury. Particular care is necessary when endoscopic papillary balloon dilation is performed in younger patients, those with a history of pancreatitis, patients with a nondilated bile duct, and when cannulation is difficult.
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Affiliation(s)
- Masanori Sugiyama
- The First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Tayar C, Brunetti F, Tantawi B, Fagniez PL. [Laparoscopic treatment of an adult gastric duplication cyst]. ANNALES DE CHIRURGIE 2003; 128:105-8. [PMID: 12657549 DOI: 10.1016/s0003-3944(02)00041-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We hereby report the case of a 24 years old woman with an adult gastric duplication cyst, a very rare congenital disease. Diagnosis was established on preoperative imaging tests. Complete resection of the duplication cyst was undertaken laparoscopically. To the best of our knowledge, this is the first report of laparoscopic resection of an adult gastric duplication cyst.
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Affiliation(s)
- C Tayar
- Hôpital Henri-Mondor, université Paris XII, Créteil, France
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Overhaus M, Decker P, Zhou H, Textor HJ, Hirner A, Scheurlen C. The congenital duplication cyst: a rare differential diagnosis of retrosternal pain and dysphagia in a young patient. Scand J Gastroenterol 2003; 38:337-40. [PMID: 12737453 DOI: 10.1080/00365520310000861] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Congenital cysts are malformations developing from the endoderm and mesoderm of the digestive and respiratory system in the early weeks of gestation. Unilocular or multilocular dysontogenic cysts are most commonly thoracically located adjacent to the trachea and bronchus and the development of an oesophageal duplication cyst in the oesophageal wall is extremely rare. The duplication cyst in the adult is usually asymptomatic and an incidental diagnosis. Potential symptoms include dysphagia and retrosternal pain. Next to endoscopy and computer tomography, endoscopic ultrasonography is mandatory for a distinguished and accurate preoperative evaluation. Transthoracic excision is crucial for definitive diagnosis and inhibition of complications.
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Affiliation(s)
- M Overhaus
- Dept. of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
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Salameh JR, Votanopoulos KI, Hilal RE, Essien FA, Williams MD, Barroso AO, Sweeney JF, Brunicardi FC. Rectal duplication cyst in an adult: the laparoscopic approach. J Laparoendosc Adv Surg Tech A 2002; 12:453-6. [PMID: 12590729 DOI: 10.1089/109264202762252758] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rectal duplication cyst (RDC) is a rare congenital anomaly representing 1% to 8% of all intestinal duplications. The case presented here is the first report of the laparoscopic resection of an RDC. METHODS We report the case of a 49-year-old white woman in whom a retrorectal cystic mass measuring 5 x 5.3 x 6 cm was diagnosed. The mass was completely resected by means of laparoscopic techniques. RESULTS Pathologic findings revealed a cystic structure partially lined with squamous as well as respiratory- and gastrointestinal-type epithelium. Muscularis propria was identified in the outer portions of the wall of the specimen. No atypia or malignancy was identified. The overall findings were consistent with an RDC. CONCLUSIONS Laparoscopic resection constitutes an excellent and patient-friendly approach to the management of large adult cystic duplication of the rectum.
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Affiliation(s)
- Jihad R Salameh
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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Affiliation(s)
- Amitabh Chak
- Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106, USA
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46
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Mediastinum. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Gastrointestinal duplications are rare congenital lesions that can develop anywhere along the alimentary tract and may present in the newborn period as an abdominal mass. They are differentiated from other intraabdominal cystic lesions by the presence of a normal gastrointestinal mucosal lining. Multiple theories have been proposed to account for these lesions; however, no single theory adequately explains all the known duplications. They are most frequently single, tubular, or cystic and located on the mesenteric side of the native alimentary tract structure. Symptoms often are related to the location of the duplication; oral and esophageal lesions can create respiratory difficulties, whereas lower gastrointestinal lesions may cause nausea, vomiting, bleeding, perforation, or obstruction. Treatment is resection with care taken to protect the common blood supply of the native structures. Occasionally, a partial resection with mucosal excision is required to preserve intestinal mucosa.
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Affiliation(s)
- L E Stern
- Division of Pediatric Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio 45229-3039, USA
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Matsushita M, Hajiro K, Okazaki K, Takakuwa H. Gastric aberrant pancreas: EUS analysis in comparison with the histology. Gastrointest Endosc 1999; 49:493-7. [PMID: 10202065 DOI: 10.1016/s0016-5107(99)70049-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Histologic diagnosis of aberrant pancreas is usually difficult when tissue samples are obtained with a standard biopsy forceps. The aim of this study was to describe the endosonographic (EUS) features of gastric aberrant pancreas. METHODS EUS was performed in 10 patients with aberrant pancreas before resection. EUS features of the lesions were analyzed and compared with resected specimens retrospectively. RESULTS EUS in 5 lesions (50%) demonstrated the ectopic pancreatic tissue as located in the third and fourth sonographic layers (submucosa and muscularis propria) and in the third layer (submucosa) in the other 5 lesions. The margin appeared for the most part indistinct (80%) because of the lobular structure of the acinous tissue. The internal echo pattern in all cases was heterogeneous, mainly a hypoechoic image (acinous tissue) accompanied by scattered small hyperechoic areas (adipose tissue). An anechoic area (duct dilatation) (80%) and fourth-layer thickening (muscular hypertrophy) (80%) were commonly visualized. CONCLUSION Gastric aberrant pancreas has characteristic EUS features that correlate with specific histologic components and is variable with regard to sonographic layer of origin.
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Affiliation(s)
- M Matsushita
- Department of Gastroenterology, Tenri Hospital, Nara, Japan
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Abstract
The case of a 13-year-old female presenting with a 6 week history of significant vomiting resulting from a gastric duplication is described. At endoscopy, an antral mass which appeared to change in size and site with peristalsis was evident. Although rare, these lesions need to be considered in the differential diagnosis of patients presenting with symptoms suggestive of gastric outlet obstruction. However, in the majority of cases, the diagnosis is rarely made prior to surgery.
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Affiliation(s)
- C S Pokorny
- Specialist Medical Centre, Liverpool, Australia
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Wang KL, Wang HP, Wu MS, Shun CT, Lee PH, Wang TH, Lin JT. Endoscopic ultrasonographic characteristics of a gastric tubular duplication. Gastrointest Endosc 1997; 46:76-9. [PMID: 9260712 DOI: 10.1016/s0016-5107(97)70216-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- K L Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei
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