Korean J Pediatr Gastroenterol Nutr.  2010 Mar;13(1):75-80. 10.5223/kjpgn.2010.13.1.75.

A Case of Intestinal Duplication Cyst Identified as Pathological Lead Point in a Child with Recurrent Intussusception

• Lee KS
• Park JY
• Oh JS
• Seong IC
• Han KM
• Lee YS

• KMID: 1459448
• DOI: http://doi.org/10.5223/kjpgn.2010.13.1.75

Abstract

Intestinal duplication cysts are characterized by the attachment to some part of the gastrointestinal tract with which a blood supply is shared, and have an epithelial lining resembling some part of the alimentary tract. A 15-month-old female was admitted to our hospital with cyclic irritability, vomiting, and blood-tinged stool. The results of an ultrasound showed an ileocolic intussusception and a 1.3 cm cystic mass had double-wall sign and a Y-configuration with an adjacent ileal loop. She had a past history of two ileocolic intussusceptions. The cystic mass was considered to be a pathologic lead point, so resection and end-to-end anastomosis was performed. The gross and histologic evaluation of the specimen demonstrated a 2.4x2.4 cm cystic mass containing yellow mucoid fluid and the cyst wall was lined with intestinal and gastric mucosa and enclosed by a layer of muscle, which was shared with the adjacent ileum.

Keyword

Intestinal duplication cyst; Intussusception; Pathologic lead point; Double wall sign; Y-configuration

MeSH Terms

Child
Female
Gastric Mucosa
Gastrointestinal Tract
Humans
Ileum
Infant
Intussusception
Muscles
Vomiting

Figure

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  Fig. 1 (A) Ultrasound shows a cystic mass with a double-layered wall consisting of an echogenic inner layer (black arrow) and a hypoechoic outer layer (white arrow). (B) A Y-configuration is shown at the junction of the cyst and adjacent small bowel (oval line).

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  Fig. 2 On a contrast-enhanced CT scan, a 2.4 cm cystic-like mass with an enhancing wall (arrow) is demonstrated in the left lower peritoneal cavity adjacent to an ileal loop.

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  Fig. 3 The gross specimen demonstrates a 2.4×2.4 cm cystic mass adjacent to an ileal loop.

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  Fig. 4 (A) Low-power histologic photomicrograph demonstrates the cyst with a layer of muscle (arrowhead) is shared with adjacent ileum, and the white box represents a low magnification lesion of (B) (H&E, ×12.5). (B) The cystic outer wall is lined with shared normal intestinal mucosa (yellow arrow) and the inner wall is lined with ectopic gastric mucosa (black arrow; H&E, ×40).

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  Fig. 5 The cystic wall consists of inner hyperechoic and outer hypoechoic layers, known as the double-wall sign, and two Y-configurations (white line) are visible at the junctions of the cyst and adjacent small bowel loop (ref. 14).

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