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

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.

Risk-reduction surgery in pediatric surgical oncology: A perspective

OBJECTIVE

A small percentage of pediatric solid cancers arise as a result of clearly identified inherited predisposition syndromes and nongenetic lesions. Evidence supports preemptive surgery for children with genetic [multiple endocrine neoplasia type 2 (MEN2), familial adenomatous polyposis syndrome (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), and hereditary diffuse gastric cancer (HDGC) and nongenetic [thyroglossal duct cysts (TGDC), congenital pulmonary airway malformations (CPAM), alimentary tract duplication cysts (ATDC), and congenital choledochal cysts (CCC)] developmental anomalies. Our aim was to explore the utility of risk reduction surgery to treat and prevent cancer in children.

METHODS

A systematic review of the available peer-reviewed literature on PubMed was performed using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) search strategy, where possible. Search items included "risk reduction surgery", "hereditary cancer predisposition syndrome", "multiple endocrine neoplasia type 2", "familial adenomatous polyposis", "hereditary nonpolyposis colorectal cancer", "hereditary diffuse gastric cancer", "thyroglossal duct cysts", congenital pulmonary airway malformations", "alimentary tract duplication cysts", "malignant transformation", and "guidelines".

RESULTS

We identified 67 articles that met the inclusion criteria describing the indications for prophylactic surgery in surgical oncology. For the genetic predisposition syndromes, 7 studies were related to professional endorsed guidelines, 7 were related to surgery for MEN2, 11 were related to colectomy for FAP, 6 were related to colectomy for HNPCC, and 12 related to gastrectomy for HDGC. Articles for the nongenetic lesions included 5 for techniques related to TGDC resection, 9 for surgery for CPAMs, and 10 for resection of ATDCs. Guidelines and strategies varied significantly especially related to the extent and timing of surgical intervention; the exception was for the timing of thyroidectomy in children with MEN2.

CONCLUSION

Current evidence supporting prophylactic surgery in the management of pediatric cancer predisposition syndromes and nongenetic lesions is best delineated for thyroidectomy to prevent medullary thyroid cancer in children with MEN2 (Strength of Recommendation Grade B/C). Despite the lack of pediatric specific evidence-based recommendations regarding the appropriate extent and timing for risk-reduction surgery for FAP, HNPCC, HDGC and nongenetic anomalies, our review represents an opportunity towards understanding the postgenomic development of these lesions and provides current indications and techniques for preemptive cancer prevention surgery in children.

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.

Complicated duplication cysts on the ileum presenting with a mesenteric inflammatory mass

Mesenteric inflammation caused by complicated duplication cysts rarely occurs. We present and discuss the imaging findings of a mesenteric inflammatory mass caused by complicated duplication cysts in an infant. Sonography showed a complex, echogenic cystic mass occupying the right subhepatic region containing two thick-walled cystic lesions inseparable from the normal bowel loop. On CT images a large, heterogeneously enhancing, hypodense peritoneal mass was observed to infiltrate the mesentery, which contained small cystic masses with enhancing thick walls. At surgery a mesenteric inflammatory mass caused by two complicated duplication cysts was found to be firmly fixed by surface contact with the ileum. A review of the literature relating to the etiologic relationship between a mesenteric inflammatory mass and complicated duplication cysts is presented.