INTERNATIONAL JOURNAL OF MEDICAL SCIENCE AND CLINICAL INVENTIONS

Volume 1 issue 10 2014 page no. 596-600 ISSN: 2348-991X

Available Online At: http://valleyinternational.net/index.php/our-jou/ijmsci

Unusual Non-Communicating Isolated Enteric Duplication Cysts

Maheshwari M. K.1, Jain Atul 2, Awasthi R.C.3 ,Agarwal Jitendra3,Prasad Akshay2,Marwah Karan2
1
Professor, Department of General Surgery, Subharti Medical College, Meerut, U.P.
2
Resident, Department of General Surgery, Subharti Medical College, Meerut U.P.
3
Assistant Professor, Department of General Surgery, Subharti Medical College, Meerut U.P.
Abstract:
Introduction
Enteric duplication cysts are uncommon congenital abnormalities that originate anywhere along the
alimentary tract from the tongue to the anus. Majority occurs in the small intestine and present in the
first year of life. The duplications share its muscular wall and blood supply with the adjacent intestine
and reside in the leaves of the mesentery. Signs and symptoms due to small intestinal duplications may
vary but abdominal distension and/or mass are the most common presentations.
Case Report
A six month old boy presented with recurrent vomiting since almost one month. Per abdomen
examination revealed a mass in the right hypochondrium, mass was cystic in consistency, non tender,
intra abdominal, not significantly mobile, and not bi-manually palpable. Ultrasound and CECT
abdomen revealed large elongated thick walled cystic lesions suggestive of possibility of enteric
duplication cysts. Exploratory laparotomy was done. A meticulous dissection of the cysts and
enucleation of the cysts was done. The post operative period was uneventful.

Conclusion
Duplication cysts should be considered in the differential diagnosis of abdominal cystic lesions. In the
case of completely isolated duplication cysts, resection can be accomplished safely without requiring
bowel resection, as demonstrated in our case.

I. INTRODUCTION
Duplications are rare congenital anomalies which
can occur anywhere in gastrointestinal tract from
mouth to anus. Only few cases are reported. As
Gray remarked “gastrointestinal tract is a fertile
field for various and curious congenital
malformations are fascinating to study for both
surgeon and pathologist” [1].
A small bowel duplication cyst is the most
common type of enteric duplication cyst, and the
ileum is the most common location [2,3]. The
prevalence of duplication cysts is 2-fold higher in
women, and they show no familial aggregation [4].
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They are either cystic or tubular. Complications,
such as bleeding, fistulization, and even malignant
degeneration, are associated with duplication cysts
[5]
.
Completely isolated duplication cysts are an
extremely rare variety of gastrointestinal
duplications with their own blood supply, and
they do not communicate with the normal bowel
segment [6–8].
Signs and symptoms due to small intestinal
duplications may vary but abdominal pain,
distension and/or mass are the most common
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2014

presentations. Small cystic duplications can act as

a lead point for small bowel intussusception or
result in localized volvulus. Large duplications
can cause compression of adjacent intestine and
cause obstructive symptoms.
Here we present a case of six month old boy
brought to hospital with complaint of vomiting and
lump in abdomen. He was diagnosed with enteric
duplication cysts and excision of duplication cyst
was done.

II. CASE REPORT

A six month old boy presented with recurrent
vomiting since almost one month. Per abdomen
examination revealed a cystic, non tender, non Photo 1
compressible lesion of size 5x3 cm in the right MRCP (Photo 2) revealed:
hypochondrium extending to right lumbar region.  Duplication cyst (esophageal and duodenal
Mass was cystic in consistency, non tender, intra enteric duplication cyst).
abdominal, not significantly mobile, not bi-  Lower esophageal duplication cyst
manually palpable. Rest of the abdomen was measures 2cc.
normal, both testes in scrotum, penis was normal.  Pancreatic head is compressed & displaced
medially by second largest cyst.
Ultrasound revealed a thick walled cystic lesion
measuring 4x3.5 cm close to second part of
duodenum. Another lobulated cystic lesion close
to the above of size 7x4 cm. No definite
communication noted. He was further evaluated
with CECT abdomen and MRCP.
CECT (Photo 1) abdomen revealed large
elongated thick walled cystic lesions (sizes 5x3cm
and 9x3cm) in right para-duodenal, porta, right
paracolic and subhepatic region compressing
displacing adjacent structures suggestive of
possibility of enteric duplication cysts.

Photo 2

Patient was planned for surgery. On exploration

there were 2 cystic lesions (Photo 3, 4). First
cystic lesion (5x3 cm) was adhered to
anterolateral wall of duodenum 2nd part. Second
lesion (9x3 cm) adhered to 3rd of duodenum
medio-lateral and adhered to pancreas. Both
lesions were non-communicating to each other

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2014

and duodenum. Both cystic lesions were excised

with meticulous dissection (Photo 5, 6). The post
operative period was uneventful. Patient was
discharged in satisfactory condition. The
histopathological examination revealed focal
cuboidal to flattened cells lining the cyst wall. The
tissue showed inflammatory changes.

Photo 6

III. DISCUSSION
Alimentary duplication cysts were first described
by Wendel in 1911. They are uncommon
congenital lesions with a reported incidence of 1
in 4500 [9]. By definition, they are located in or
adjacent to the wall of part of the gastrointestinal
tract, they have smooth muscle in their walls, and
they contain some type of intestinal mucosal layer
within the lumen. The mucosal lining within
Photo 3
alimentary tract duplications may display
components of several different types of GI tract
or respiratory tract mucosa [10].
Enteric duplication cysts usually share a common
wall with the normal intestine and have a common
blood supply. “Isolated duplication” or
“completely isolated duplication” of the
alimentary are an extremely rare variety of
gastrointestinal duplications.
More than 80% of enteric duplications present
before the age of two years, usually with intestinal
Photo 4 obstruction or a palpable mass [11, 12]. Most of the
adult intestinal duplications are asymptomatic and
remain undiagnosed for years. Acute onset or
chronic complaints or both are possible
presentations in adults. Common findings are
palpable mass and bowel obstruction [13]. Rare
presentations are bleeding from ulceration within
the duplication, fistula formation with nearby
structures [14], and infection of the cyst. Also it has
been reported that enteric duplication may be the
site of adenocarcinoma [15].
In our case, based upon CT and sonographic
findings, a small bowel duplication cyst was
Photo 5 tentatively diagnosed. MRCP was done to look for

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presence of CBD and hepatobiliary pathology if
any.
The differential diagnosis includes all cystic
intraabdominal masses, such as mesenteric and
omental cysts, pancreatic pseudocysts, and
ovarian cysts [16,17]. There is no worldwide
accepted therapeutic algorithm for duplication
cysts.
IV. CONCLUSION
Duplication cysts should be considered in the
differential diagnosis of abdominal cystic lesions.
In the case of completely isolated duplication
cysts, resection can be accomplished safely
without requiring bowel resection, as
demonstrated in our case.
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