Duplication cyst

Partial duodenal obstruction may be produced by duodenal stenosis, duodenal web, Ladd s bands, midgut volvulus, annular pancreas, preduodenal portal vein, and duplication cyst. Plain radiographs show gaseous distension of the stomach and duodenum with a normal or diminished quantity of air in the small bowel. Content studies may be necessary to differentiate between midgut volvulus and partial duodenal obstruction caused by a web or stenosis (Auringer and Sumner 1994). Sonography is helpful to rule out extraluminal causes such as a duplication cyst. 

Most childhood cases of intussusception are idiopathic. Intussusception lead points such as a Meckel diverticulum, duplication cyst, polyp, or tumor (e.g. lymphoma) are uncommon in infants (<5% of cases). Intussusception lead points are more common in neonates, older children (> 5 years old), and cases restricted to the small intestine. For example, intussusception of the small intestine is common in Peutz-Jeghers syndrome, Schonlein-Henoch purpura, and after surgery. US allows... 

Fig. 2.14a-d. Esophageal duplication cyst, a AP chest radiograph without appreciable abnormality, b Lateral chest radiograph with anterior bowing and narrowing of the airway above the carina. c Barium esophagram confirms the presence of a soft tissue mass, d Contrast-enhanced CT shows the cyst posterior to the airway, and deforming the airway arrow)... 

Ultrasound (US) is now increasingly used for the evaluation of the upper GI tract, for instance to evaluate for wall thickness or a duplication cyst. In other instances, it may be necessary to fill the stomach with fluid before the examination, e.g. in the evaluation of gastroesophageal reflux or hypertrophic pyloric stenosis. 

Fig. 3.3. US of duplication cyst of the greater curvature of the stomach classic double echo pattern of the G1 mucosa. (Courtesy of Dr. Carlo Buonomo, Boston, MA, USA)...

Patients with functioning ectopic gastric mucosa will present with pain, bleeding and perforation. However, patients with intrathoracic foregut duplication cysts, mainly younger patients, will present with respiratory distress caused by compression of the airway. 

Congenital Diseases in the Infant 177 Volvulus 177 Meckel Diverticulum 177 Duplication Cysts 178 Intraperitoneal Cysts 179... 

Some of the pathologies of the small intestine are discussed in Chapter 1. In the current chapter, therefore, little or no attention will be paid to (midgut volvulus) malrotation, the atresias, meconium ileus, meconium peritonitis, duplication cysts, necrotizing enterocolitis (NEC) and intussusception. 

Fig. 5.9. Ileal duplication cyst in an infant with meconium peritonitis. Note the additional punctate calcifications and echogenic meconium intraperitoneally (arrows)...

Plain film, US, contrast examination, scintigraphy and even CT and MRI can be useful to diagnose a duplication cyst. Plain film may show obstruction. US may show the non-communicating anechoic cystic duplication cysts with the clearly visible. 

Fig. 5.15. a A non-communicating duplication cyst of duodenum. Note the echogenic mucosal layer and hypoechoic muscular layer and the inhomogeneous content of the cyst, b Colonic duplication. US demonstrates mucosal echogenic stripe ( rroivs). c (1) (11) CT of colon duplication... 

There are three types of lymphangiomas the simple capillary, cavernous and cystic types. At least half have ahaemangiomatous component. Most abdominal lymphangiomas are located in the mesentery and omentum, and are called mesenteric and omental cysts, respectively. They are caused by sequestration or obstruction of lymphatic vessels, are mono- or multilocular and can calcify in case of necrosis. The wall of mesenterial and omental cyst is unilayered, which is in contrast to the multilayered aspect of the wall of the duplication cyst. Most cysts are asymptomatic, but because of bleeding or infection they can cause fever and pain and can necrotize after torsion. Adherent cysts to the bowel can cause partial obstruction. Some cause a painless abdominal distension and palpable mass (Carty et al. 2005 Parker 2003 Devos and Meradji 2003). 

Patients normally present in the neonatal period or in infancy and there is a male-to-female ratio of 1 2. The patient may present with constipation, with obstruction if the cyst is of large size, or may present with bleeding if the cyst communicates with the normal gut lumen, and if there is ulceration of gastric mucosa within the duplication cyst. Duplication cysts may be associated with recto-genital or recto-urinary fistula, duplication of the internal or external genitalia, vertebral anomalies and multi-system congenital anomaly complexes. Female patients... 

Fig. 6.12a-c. Duplication cyst of the colon, a Contrast enema outlines the filling defect of a caecal duplication cyst, b Ultrasound of a duplication cyst at the hepatic fiexure. c High resolution ultrasound in the same patient shows the layers of the cyst wall and some echogenic debris within it... 

Godfrey H, Abernethy L, Boothroyd A (1998) Torsion of an ovarian cyst mimicking enteric duplication cyst on transabdominal ultrasound two cases. Pediatr Radiol 28 171-173... 

Fig. 2.40a-e. Duodenal Duplication Cyst. Endoscopy (a,b) demonstrates a smooth submucosal mass extending caudally from the major papilla, covered with normal mucosa. Note the normal papilla (a). Endoscopic- ultrasound (c) confirms the cystic nature of the lesion. The resection specimen (d) shows the intraluminal component of the cyst and histopathology (e) the inner- and outer epithelial lining of the duodenal duplication cyst... 

Fig. 5.17a,b. Duodenal duplication cyst a Barium study showing a relatively smooth impression arising from the medial wall of the descending duodenum extending around the inferior duodenal flexure, b CT of the same patient confirms the fluid nature of the cyst... 

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