Pediatr Gastroenterol Hepatol Nutr.  2017 Sep;20(3):194-197. 10.5223/pghn.2017.20.3.194.

Giant Duplication Cyst Presenting as a Discharging Umbilicus

• Garg RK
• Bawa M
• Narasimha Rao KL

• KMID: 2390551
• DOI: http://doi.org/10.5223/pghn.2017.20.3.194

Abstract

Alimentary tract duplication cysts are rare congenital anomalies, most commonly located in the ileum, but may present anywhere from mouth to anus.Clinically, they may be asymptomatic, incidentally diagnosed or may present with obstruction, volvulus, intussusception or gastrointestinal bleed. Here we report a case of a one year old male child presenting in gasping state and shock. Despite the initial strong suspicion of Meckel's diverticulum and tubercular abdomen, the final diagnosis remained elusive till exploratory laparotomy was performed which revealed a duplication cyst of ileum with perforation into the umbilicus. Duplication cyst should always be kept as a differential diagnosis so that early intervention can help in better management.

Keyword

Duplication cyst; Ileum; Ascites; Umblicus; Gastrointestinal bleed

MeSH Terms

Abdomen
Ascites
Child
Diagnosis
Diagnosis, Differential
Early Intervention (Education)
Humans
Ileum
Intestinal Volvulus
Intussusception
Laparotomy
Male
Meckel Diverticulum
Mouth
Shock
Umbilicus*

Figure

• 

  Fig. 1 A contrast enhanced computed tomography abdomen. Gross ascites pushing the gut loops centrally and posteriorly.

• 

  Fig. 2 (A) Duplication cyst in mesentery of ileum. (B) Communication of cyst with ileum hooked with artery forceps. (C) Curved arrow: point of attachment with ileum, solid arrow pointing right: site of perforation and attachment with umbilicus, solid arrow pointing up: blind end of duplication cyst.

Reference

1. Lund DP. Alimentary tract duplications. In : Coran AG, Adzick NS, Krummel TM, Laberge JM, Shamberger RC, Caldamone AA, editors. Pediatric surgery. 7th ed. Philadelphia: Saunders;2012. p. 1155–1165.

2. Schalamon J, Schleef J, Höllwarth ME. Experience with gastro-intestinal duplications in childhood. Langenbecks Arch Surg. 2000; 385:402–405.

3. Grosfeld JL, O'Neill JA Jr, Clatworthy HW Jr. Enteric duplications in infancy and childhood: an 18-year review. Ann Surg. 1970; 172:83–90.

4. Chen JJ, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC. Meta-analysis: the clinical features of the duodenal duplication cyst. J Pediatr Surg. 2010; 45:1598–1606.

5. Williams WH, Hendren WH. Intrapancreatic duodenal duplication causing pancreatitis in a child. Surgery. 1971; 69:708–715.

6. Li L, Zhang JZ, Wang YX. Vascular classification for small intestinal duplications: experience with 80 cases. J Pediatr Surg. 1998; 33:1243–1245.

7. Holcomb GW 3rd, Gheissari A, O'Neill JA Jr, Shorter NA, Bishop HC. Surgical management of alimentary tract duplications. Ann Surg. 1989; 209:167–174.