Ileocecal duplication cysts: is the loss of the valve always necessary?

Ileal duplication in adults: A rare case

INTRODUCTION AND IMPORTANCE

Intestinal duplication is an uncommon congenital malformation affecting the alimentary tract. This article presents a case of enteric duplication cyst (EDC) in an adult, accompanied by a review of the available literature.

CASE PRESENTATION

A 34-year-old woman with polymyositis underwent a routine CT scan as part of her medical assessment revealing an 8 cm mass near the caecum and terminal ileum. Diagnostic procedures confirmed a cystic spherical mass. The patient underwent ileo-cecal resection, with primary anastomosis and an uneventful recovery.

CLINICAL DISCUSSION

Studies indicate that the frequency of polymyositis coexisting with a neoplasm range from 6 % to 40 %. Therefore, a body CT scan is recommended for patients with myopathy as in our patient. Intestinal duplications are predominantly found in children but can also occur in adults, often discovered incidentally or due to complications. Diagnostic imaging techniques, such as ultrasonography and CT scan, are crucial in identifying duplication location and characteristics. In this case, colonoscopy indicated ileocecal valve compression, and histological examination confirmed an enteric duplication cyst with ectopic gastric mucosa.

CONCLUSION

Enteric duplication cysts are rare, and the existing literature on the topic somewhat limited. Early diagnosis and surgical intervention are essential to stave off potential complications and reduce morbidity. Clinician awareness of enteric duplication cysts enables timely management, enhancing patient outcomes. Further research is needed to improve understanding and optimize patient care.

Cecal Duplication Cyst: A New Surgical Intervention

This case report of an infant details a rare occurrence of a cecal duplication cyst causing bowel obstruction. It was successfully treated through an extra mucosal enucleation. The patient presented at 41 days of life, with two days picture of abdominal distension and recurrent non-bilious vomiting. The infant improved initially, but subsequently, he developed bilious vomiting. Further investigations revealed a suspected ileocolic intussusception and small bowel obstruction. Surgical exploration revealed a cecal duplication cyst. The cyst was enucleated, and closure of the seromuscular defect was done with an appendectomy. The patient had a smooth recovery postoperatively. Histopathology confirmed the presence of a duplication cyst with benign ectopic gastric tissue negative for malignancy. The patient was discharged without any complications.

Case report: Ileocecal preservation for multiple small intestinal duplications

Small-intestinal duplication is a rare congenital developmental anomaly that is mainly single; multiple small-intestinal duplications are rare. Most malformations are located in the ileocecal region. The primary surgical treatment is complete resection of the malformations and adjacent intestinal ducts. However, the ileocecal junction plays an important role in children, and it is difficult to preserve it; multiple intestinal repairs increase the risk of postoperative intestinal fistula, which is a challenge for pediatric surgeons. Herein, we report a case of ileocecal preservation surgery for the treatment of multiple small intestinal duplication malformations near the ileocecal area. The child underwent laparoscopically assisted cyst excision and multiple intestinal repairs and had good postoperative recovery and follow-up.

Ileocecal valve-sparing surgery for duplication cysts in the terminal ileum: two case reports and literature review

Background

Duplication cysts close to the ileocecal valve are usually treated with ileocecal resection. However, loss of the ileocecal valve will lead to problems, especially in infants. Mucosectomy of the cyst would be a better alternative that preserves the ileocecal valve. We report two cases of duplication cyst in the terminal ileum successfully treated with mucosectomy.

Case presentation

Case 1. A 3-month-old boy with bilious emesis and abdominal distention was referred to our hospital with a diagnosis of small bowel obstruction caused by an abdominal cyst. Computed tomography revealed a cystic mass compressing the terminal ileum and causing mechanical small bowel obstruction. His general condition deteriorated quickly; emergency laparotomy was performed. Although the small intestines were dilated and partially twisted, there was no necrosis. Following intestinal decompression, a cystic mass adjacent to the terminal ileum was confirmed on the mesenteric side. Cyst mucosectomy was performed to preserve the ileocecal valve. Case 2. A 5-month-old boy with sudden onset of hematochezia was referred to our hospital with a diagnosis of intussusception. Following unsuccessful contrast enemas, emergency surgery was performed. A cystic mass adjacent to the terminal ileum was confirmed; there was no intussusception. Cyst mucosectomy was performed. Both patients had an uneventful postoperative course.

Conclusions

Cyst mucosectomy, which preserves the ileocecal valve, is safe and effective for treating duplication cysts in the terminal ileum.

Ileocecal duplication in children: a single-center experience of 115 cases

To evaluate the clinical features, surgical management, and prognosis of ileocecal duplication in children. A total of 115 patients diagnosed with ileocecal duplication at Beijing Children's Hospital between January 2010 and June 2021 were retrospectively reviewed. Ileocecal duplications were divided into ileal intraluminal (n = 41), ileal extraluminal (n = 24), ileocecal valve (n = 11), cecal intraluminal (n = 18), and cecal extraluminal (n = 3) types according to their locations. Median age at diagnosis was 9.5 (0.1-169.2) months. Intussusception was only observed preoperatively in patients with the ileal intraluminal (8/41), ileocecal valve (4/11), and cecal intraluminal (7/18) types (P = 0.004). Ileocecal resection and ileocolostomy and cyst excision without ileocecal resection were performed in 41 (35.7%) and 74 (64.3%) patients, respectively. The proportions of cyst excision without ileocecal resection performed in patients with different types were 78.0% (32/41), 91.7% (22/24), 27.3% (3/11), 27.8% (5/18), and 100.0% (3/3) (P < 0.001). Time of oral intake (P = 0.003) and hospital stay after surgery (P < 0.001) were significantly shorter in patients undergoing cyst excision without ileocecal resection. There were no significant differences in the complications, growth, and stool frequency (older than 4 years) between patients undergoing different surgical procedures. Regarding the stool consistency (older than 4 years), there was a lower proportion of dry stool in patients undergoing cyst excision (P = 0.008).

CONCLUSIONS

Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. At mid-term follow-up, the children's growth and defecation patterns do not seem to be affected by ileocecal resection.

WHAT IS KNOWN

• How to address ileocecal duplication has always been challenging in clinical management. • Children who have an ileocecal resection can develop some early postoperative complications.

WHAT IS NEW

• Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. • Children's growth and defecation patterns do not seem to be affected by ileocecal resection.

Does Ileocecal Resection Affect Children's Medium-Long-Term Growth and Defecation Patterns? A Matched Case-Control Study

BACKGROUND

Ileocecal resection leads to some early complications, but it is unknown whether it affects children's medium-long-term growth and defecation patterns. To determine if there was an association, we conducted this matched case-control study.

METHODS

This study was conducted in Beijing Children's Hospital and included three groups: the case group (n = 30) included patients with ileocecal duplication undergoing ileocecal resection between January 2010 and June 2021, the control group (n = 90) included outpatient patients without ileocecal resection in January 2022, and the appendectomy group (n = 90) included patients who underwent appendectomy between January 2010 and June 2021. The 1:1 matching criteria included gender and age (within 1 year). The evaluation indicators were growth (height-for-age, BMI) and defecation patterns (stool frequency, stool consistency) over 6 months after surgery. Defecation patterns were assessed in patients older than 4 years. Stool consistency was evaluated by the modified Bristol Stool Form Scale.

RESULTS

There were no significant differences, except for stool consistency, between the case and control groups regarding their growth and defecation patterns before case-control matching. The patients in the case group had a significantly higher prevalence of dry stool (P < 0.008). After case-control matching, there were no significant differences in the growth and defecation patterns between the case and control groups. Before and after case-control matching, there were no significant differences in the defecation patterns between the control group and the appendectomy group.

CONCLUSION

Children's medium-long-term growth and defecation patterns were not affected by ileocecal resection.

Intraluminal Duplication of the Terminal Ileum with Ectopic Gastric Mucosa in an Infant: A Rare Cause of Intussusception

Enteric duplication cysts are rare malformations mostly diagnosed before the age of two, with varied clinical presentations. Ectopic gastrointestinal epithelium can be present, and management involves surgical resection. A three-month-old girl presented with rectal bleeding due to an ileocolic intussusception. Abdominal ultrasound revealed a target sign in the right upper part of the abdomen. At hydrostatic contrast enema, an incomplete reduction of the intussusception was obtained: only a trickle of contrast material entered the terminal ileum. An exploratory laparotomy ensued with manual reduction of the intussusception. At the end of the maneuver, a soft intraluminal mass was palpated within the ileocecal valve. Thus, an ileocecal resection was performed. At histology, an intraluminal enteric duplication cyst was documented, containing ectopic gastric mucosa. Secondary intussusception should be suspected even in infants in case of abnormal findings at hydrostatic contrast enema. Intraluminal enteric duplication cysts may be a rare cause of intussusception.

Laparoscopic resection of ileocaecal duplication in children (report of 15 cases)

Background:

Enteric duplication is a congenital anomaly with varied clinical presentation that requires surgical resection for definitive treatment. Ileocaecal (IC) duplications are duplications located at the IC junction, not clearly identified in all the published series. The reported treatment is IC resection and ileocolic anastomosis. The purpose of our study was to present our experience in successfully resection of IC duplication by laparoscope, thus avoiding bowel resection in children.

Materials and Methods:

A retrospective review was conducted of medical records of 15 patients with diagnosis of IC duplication, treated in the Department of Paediatric Surgery of our hospital, within the period from November 2013 to September 2018.

Results:

Laparoscopic resection of IC duplication was successfully performed in all children without bowel resection. The operation time was 50–90 min (55 ± 10 min), and the post-operative hospitalization time was 5–7 days (average, 6 days). The 15 patients were followed up for 6–12 months (average, 10 months). No recurrence was found by abdominal ultrasound examination. The wound had small scars with good appearance of umbilicus.

Conclusions:

The laparoscopic approach allows for confirming the diagnosis and accurately defining the exact site of duplication, as well as for effective and safe treatment. Laparoscopic excision of IC duplication without bowel resection is a safe option and is worth promoting.

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.