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Nomura Y, Nagayama S, Fujioka S, Takeuchi G, Takeuchi Y, Okamoto M, Ganeko R, Nakayama Y, Hashimoto K, Kubota Y. Two Cases of Adult-Onset Intestinal Duplication Manifested as Acute Abdomen: Case Report and Review of the Literature. Surg Case Rep 2025; 11:24-0023. [PMID: 40008372 PMCID: PMC11850214 DOI: 10.70352/scrj.cr.24-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 01/06/2025] [Indexed: 02/27/2025] Open
Abstract
INTRODUCTION Gastrointestinal duplication is a rare congenital anomaly, usually occurring in childhood and rarely in adults. It is most common in the ileum, but can occur anywhere in the gastrointestinal tract from the mouth to the anus. An adult case of intestinal duplication is accompanied by non-specific symptoms and, hence, it is often difficult to establish accurate diagnosis preoperatively in adults. CASE PRESENTATION We experienced two cases of ileal duplication that was manifested as acute abdomen. In both cases, we performed emergency surgery with a tentative preoperative diagnosis of perforation peritonitis related to intestinal duplication. The first case was a 36-year-old male presenting with a cystic non-communicating intestinal duplication, which was perforated, causing abdominal pain. The second case was a 77-year-old male presenting with tubular communicating intestinal duplication, in which a fecal stone was fitted into the root of the duplicated intestine, and the duplicated intestine itself became abscessed, causing abdominal pain. Their postoperative courses were uneventful and the patients were discharged from hospital without any sequelae on the 5th and 10th postoperative day, respectively. CONCLUSION Although preoperative diagnosis is not easy, because the clinical presentation varies depending on the occurrence site, in-depth evaluation of preoperative CT images could lead to a precise diagnosis especially when considering intestinal duplication as one of the differential diagnoses of acute abdomen.
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Affiliation(s)
- Yuki Nomura
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Satoshi Nagayama
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Sachie Fujioka
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Go Takeuchi
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Yuma Takeuchi
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Michio Okamoto
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Riki Ganeko
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Yusuke Nakayama
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Kyoichi Hashimoto
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
| | - Yoshihiro Kubota
- Department of Surgery, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
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Chen F, Liu J. Colonoscopy diagnosis of recurrent abdominal pain in a 4-year-old boy with intestinal duplication cyst involving colon, appendix, and ileum: a case report. J Med Case Rep 2024; 18:444. [PMID: 39307876 PMCID: PMC11418190 DOI: 10.1186/s13256-024-04780-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Intestinal duplication cyst is an infrequent congenital malformation that can involve all the segments of the gastrointestinal tract. The cases of intestinal duplication cyst involving the colon, appendix, and ileum in children are particularly uncommon. The symptoms of abdominal pain are similar to other acute abdominal diseases in children, such as appendicitis, intussusception, and intestinal obstruction, so sometimes its diagnosis is challenging and leads to misdiagnosis. CASE PRESENTATION We report a 4-year-old Asian boy who presented to the pediatric emergency department with abdominal pain and vomiting but no fever, peritonitis, or mass. No abdominal abnormality was found via radiology and ultrasonography. After 2 days' anti-inflammatory therapy, the patient was discharged with pain relief. A total of 9 months later, he was readmitted to the pediatric emergency department for the same complaint as the first admission. Abdominal physical examination and ultrasound examination were still negative. Barium examination found a large mass in the colon. Colonoscopy was performed before operation to confirm the rare co-cavity intestinal duplication cyst involving the colon, appendix, and ileum. After resection of intestinal duplication and ileocolonic anastomosis, the patient's abdominal pain and vomiting has not recurred for 5 years postoperatively. CONCLUSIONS The diagnosis of intestinal duplication cyst in children is difficult, especially the rare co-cavity and long segmental intestinal duplication, which is easily misdiagnosed. Colonoscopy may be an effective auxiliary diagnostic method, especially for diseases that are difficult to diagnosed clinically, such as recurrent abdominal pain.
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Affiliation(s)
- Faling Chen
- Department of General Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, China
| | - Jiangbin Liu
- Department of General Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, China.
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Gurzu S, Burlacu D, Jung I. Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management. JOURNAL OF ONCOLOGY 2022; 2022:6983460. [PMID: 35586207 PMCID: PMC9110201 DOI: 10.1155/2022/6983460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To perform the first systematic report about histological subtypes of nonpolypous hamartomas of the gastrointestinal (GI) tract, from esophagus to anal canal. DESIGN From over 19,000 studies about hamartomas, most of them published as case series or case presentations, we have selected the most representative ones for the GI tract, excluding polyposis syndromes. To have a whole picture of these hamartomas, all of the data were combined with the personal experience of the authors who are GI pathologists. RESULTS The examined articles showed predominance of vascular and combined vascular and mesenchymal hamartomas. Arteriovenous hamartomas or Brunner gland hamartomas are mainly diagnosed in the small intestine, with preponderance for duodenum. Other malformations such cavernous hamartomas are more specific for the colorectal segments, whereas chondromatous hamartomas or those derived from the neural ectoderm were mostly reported in the esophagus. As newly recognized entities were admitted in the last years, misdiagnosis is frequent, and the best therapeutic approach is far to be known. CONCLUSION Even rare, hamartomas of the GI tract need to be differentiated from tumors and familial polyposis syndromes. Knowing their proper denominations and possible complications is valuable for gastroenterologists, pathologists, and surgeons, to be aware in the differential diagnosis.
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Affiliation(s)
- Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
- Research Center of Oncopathology and Transdisciplinary Research (CCOMT), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
- Department of Pathology, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Diana Burlacu
- Department of Pathology, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Ioan Jung
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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Niwa Y, Tominaga K, Kawata Y, Kobayashi T, Mizuwasa T, Takahashi K, Sato H, Kohisa J, Abe S, Kamimura K, Yokoyama J, Kawai H, Sugino H, Umezu H, Hirai Y, Nakano M, Shimada Y, Kameyama H, Wakai T, Terai S. Intestinal duplication diagnosed preoperatively with double-balloon enteroscopy: an extremely rare case report and literature review. Clin J Gastroenterol 2022; 15:381-387. [PMID: 35064919 DOI: 10.1007/s12328-022-01596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
Gastrointestinal duplications are congenital malformations that are usually observed in pediatric patients. Diagnosis in adulthood is quite rare, and preoperative diagnosis of gastrointestinal duplication is difficult, particularly in the small intestine. We encountered an extremely rare adult case of duplication of the jejunum, which showed a stomach-like form diagnosed using double-balloon enteroscopy (DBE). The patient was an 18-year-old male who had been experiencing upper abdominal pain and vomiting repeatedly without any triggers for 3 years. Various examinations were performed, but no cause of symptoms was found. DBE revealed a narrow opening of the lumen at the upper jejunum, and the lumen was covered with mucosal folds similar to those of the stomach. Enteroclysis via DBE showed a tubular structure on the mesenteric side of the jejunum. We diagnosed a jejunal tubular duplication with ectopic gastric mucosa and underwent partial small bowel resection. The patient's abdominal symptoms resolved. From this, DBE can be a useful tool for diagnosing intestinal duplication in adults. We believe that this case and literature review will facilitate the accurate and prompt diagnosis of small intestinal duplication.
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Affiliation(s)
- Yusuke Niwa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan.
| | - Yuzo Kawata
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Takamasa Kobayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Takeshi Mizuwasa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Kazuya Takahashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Hiroki Sato
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Junji Kohisa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Satoshi Abe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
| | - Hideaki Sugino
- Division of Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-ku, Niigata, Japan
| | - Hajime Umezu
- Division of Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-ku, Niigata, Japan
| | - Yumiko Hirai
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-ku, Niigata, Japan
| | - Masato Nakano
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-ku, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-ku, Niigata, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-ku, Niigata, Japan
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-ku, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 9518510, Japan
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Unique Findings of Retrograde Double-Balloon Enteroscopy in a Rare Adult Case of Ileal Duplication. ACG Case Rep J 2020; 7:e00511. [PMID: 33354586 PMCID: PMC7748165 DOI: 10.14309/crj.0000000000000511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/04/2020] [Indexed: 02/05/2023] Open
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Xiao-Ming A, Jin-Jing L, Li-Chen H, Lu-Lu H, Xiong Y, Hong-Hai Z, Nian-Yin Y. A huge completely isolated duplication cyst complicated by torsion and lined by 3 different mucosal epithelial components in an adult: A case report. Medicine (Baltimore) 2018; 97:e13005. [PMID: 30383655 PMCID: PMC6221613 DOI: 10.1097/md.0000000000013005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Intestinal or enteric duplication (ED) does exit as a rare congenital malformation of the gastrointestinal system clinically. It is a separate entity, but can be communicated with the gastrointestinal tract. It is characterized by a well-developed muscular wall and lumen endowed with ectopic mucosa, simulating a portion of normal bowel. A completely isolated duplication cyst (CIDC) refers to an extremely uncommon variant of ED, which is secluded from the alimentary tract and possesses its own exclusive blood supply. Surgical procedure is the treatment of choice, because most often, a definitive diagnosis can only be confirmed intraoperatively. PATIENT CONCERNS A 20-year-old male patient presented with a 10-day history of intermittent episodes of abdominal pain. The pain evolved from dull into progressive and intolerable, accompanied by vomiting, nausea, and abdominal distention. DIAGNOSES Closed-loop small-bowel obstruction with volvulus. INTERVENTIONS The patient underwent an emergency exploratory laparotomy. OUTCOMES A huge CIDC was observed upon operation, which was affixed to the mesentery with only a narrow base, just like a pedicle; 720° counterclockwise twisting around its base was definitely noted, provoking the compromised blood supply. Complete excision of the cyst was performed along its base safely without violating the intestinal tract. Furthermore, the ectopic mucosa of the cyst exhibited 3 different epithelial lining components histopathologically. LESSONS Clinicians should be aware of the possibility of the existence of a duplication and raise a high index of suspicion in case of equivocal diagnosis, particularly in adult population. A low threshold for surgical management should be recommended in order to prevent lethal outcomes.
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Takegawa Y, Hiramatsu K, Murata Y, Akazawa Y, Saito Y, Ozaki Y, Takahashi K, Naito T, Ofuji K, Matsuda H, Ohtani M, Nemoto T, Suto H, Goi T, Imamura Y, Nakamoto Y. Duplication cyst of the ileum presenting with severe anemia detected by double-balloon endoscopy. Endosc Int Open 2018; 6:E395-E398. [PMID: 29607390 PMCID: PMC5876031 DOI: 10.1055/s-0043-125142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/22/2017] [Indexed: 01/31/2023] Open
Abstract
Background and study aims Duplication cysts of the ileum are rare and present with non-specific clinical manifestations such as abdominal pain, vomiting, melena, and intussusception. Therefore, preoperative diagnosis is difficult. Here, we report a case of duplication cyst of the small intestine that was diagnosed preoperatively using double-balloon enteroscopy. A 19-year-old man presented with severe iron deficiency anemia, abdominal pain, and exertional dyspnea. Gastroscopy and colonoscopy revealed no remarkable findings. Abdominal computed tomography revealed a cystic structure in the ileum. Therefore, we performed double-balloon enteroscopy via the anal route. The intestinal tract was bifurcated, with one segment ending in a blind sac containing normal villi and an ulceration. Tc-99 m pertechnetate scintigraphy showed no accumulation in the lesion. Accordingly, we diagnosed a duplication cyst and suspected that this was the cause of severe anemia. Following small bowel resection with cyst excision and anastomosis, the anemia and presenting symptoms resolved. This report highlights the usefulness of double-balloon enteroscopy of the small intestine for preoperative diagnosis of the obscure gastrointestinal bleeding, including duplication cysts .
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Affiliation(s)
- Yumi Takegawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Katsushi Hiramatsu
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Yosuke Murata
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Yu Akazawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Yasushi Saito
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Yoshihiko Ozaki
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Kazuto Takahashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Tatsushi Naito
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Kazuya Ofuji
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Hidetaka Matsuda
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Masahiro Ohtani
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Tomoyuki Nemoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Hiroyuki Suto
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan
| | - Takanori Goi
- First Department of Surgery, Faculty of Medical Sciences, Fukui University, Fukui Japan
| | - Yoshiaki Imamura
- Division of Surgical Pathology, University of Fukui Hospital, Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, Fukui University, Fukui, Japan,Corresponding author Yasunari Nakamoto, MD, PhD Second Department of Internal MedicineFaculty of Medical Sciences, Fukui University23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gunFukui 910-1193, Japan+81-776-61-8110
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Huang ZH, Wan ZH, Vikash V, Vikash S, Jiang CQ. Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin. SAO PAULO MED J 2018; 136:89-93. [PMID: 29236936 PMCID: PMC9924164 DOI: 10.1590/1516-3180.2017.0184030817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022] Open
Abstract
CONTEXT To study the previously discovered clinical entity of adult intestinal duplication and its treatment, and propose an extension to its existing classification. CASE REPORT We report the case of an adult male with abdominal pain, constipation and vomiting. This patient underwent surgical separation of adhesions, reduction of torsion and intestinal decompression. Postoperative pathological findings confirmed the rare diagnosis of intestinal duplication. CONCLUSION Adult intestinal duplication is quite rare. Its clinical manifestations are nonspecific. From this finding of intestinal duplication originating at the opposite side of the mesenteric margin, a further extension of the existing anatomical classification is proposed.
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Affiliation(s)
- Zhi-Hao Huang
- MD, MSc. Surgeon, Department of Colorectal and Anal Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.
| | - Zi-Hao Wan
- MD, MSc. Surgeon, Department of Orthopedic Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.
| | - Vikash Vikash
- MD, PhD. Physician, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
| | - Sindhu Vikash
- MD, PhD. Physician, Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh, Pakistan.
| | - Cong-Qing Jiang
- MD, PhD. Surgeon, Department of Colorectal and Anal Surgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei Province, China.
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Gurzu S, Bara Jr T, Bara T, Fetyko A, Jung I. Cystic jejunal duplication with Heinrich’s type I ectopic pancreas, incidentally discovered in a patient with pancreatic tail neoplasm. World J Clin Cases 2016; 4:281-284. [PMID: 27672644 PMCID: PMC5018626 DOI: 10.12998/wjcc.v4.i9.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/03/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to present a case of enteric duplication cyst and criteria for a proper differential diagnosis. A 51-year-old male was hospitalized for pancreatic tail neoplasm and distal pancreatectomy with splenectomy was performed. During surgery, a jejunal cystic lesion was incidentally detected and jejunectomy was performed. Microscopically, the cyst was observed to be covered by Keratin 7/Keratin 20 positive intestinal type epithelium and the muscularis layer was shared by the cyst and adjacent jejunum, without a cleavage plane between the cyst wall and jejunal muscularis propria. In the deep muscularis propria, a Heinrich’s type I ectopic pancreas was also noted. In the pancreatic tail, a low grade intraepithelial lesion (panIN-1a) was diagnosed. This case highlights the necessity for a correct differential diagnosis of such rare lesions. Roughly 30 cases of jejunal duplication cysts have been reported to date in the PubMed database.
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Matsumoto Y, Tohma T, Miyauchi H, Suzuki K, Nishimori T, Ohira G, Narushima K, Muto Y, Maruyama T, Matsubara H. A case of giant ileal duplication in an adult, successfully treated with laparoscope-assisted surgery. Surg Case Rep 2016; 1:10. [PMID: 26943378 PMCID: PMC4747944 DOI: 10.1186/s40792-015-0019-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/09/2015] [Indexed: 01/29/2023] Open
Abstract
Alimentary tract duplication is a rare congenital malformation but can occur anywhere along the digestive tract. Most patients become symptomatic in early childhood, and only a few cases of adult patients have been reported in the literature. We herein report a unique case of a giant ileal duplication in an adult, which was successfully treated with laparoscope-assisted surgery. A 60-year-old male was admitted because of abdominal pain. Imaging studies revealed a well-defined cystic mass, measuring 15 cm, in the ileocecal region. We diagnosed it as a duplicated ileum and performed laparoscope-assisted surgery. The duplication was successfully resected with attached normal ileum, and there were no major complications in the postoperative course.
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Affiliation(s)
- Yasunori Matsumoto
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Takayuki Tohma
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Hideaki Miyauchi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Kazufumi Suzuki
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Takanori Nishimori
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Gaku Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Kazuo Narushima
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Yorihiko Muto
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Tetsuro Maruyama
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
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Araki A, Tsuchiya K, Watanabe M. Advances in balloon endoscopes. Clin J Gastroenterol 2015; 7:189-99. [PMID: 26183736 DOI: 10.1007/s12328-014-0485-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/25/2014] [Indexed: 01/10/2023]
Abstract
In September 2003, a double-balloon endoscope (DBE) composed of balloons attached to a scope and an overtube was released in Japan prior to becoming available in other parts of the world. The DBE was developed by Dr. Yamamoto (1), and 5 different types of scopes with different uses have already been marketed. In April 2007, a single-balloon small intestinal endoscope was released with a balloon attached only to the overtube as a subsequent model. This article presents a detailed account of the development of these scopes up to the present time.
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Affiliation(s)
- Akihiro Araki
- Department of Gastroenterology and Hepatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan,
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12
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Abstract
Alimentary tract duplications are rare congenital anomalies that usually present in childhood and occasionally in adults. They are most common in the ileum, but can occur anywhere along the alimentary tract from the mouth to the anus. We report a 24-year-old woman who presented with a giant chylous ileum cyst duplication. To our knowledge, there is only one other report of a patient with a giant chylous cyst in the literature.
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Pandey S, Srivastava A, Lal R, Yachha SK, Poddar U. Enteric duplication cysts in children: a target in algorithm for evaluation of lower gastrointestinal bleeding. Indian J Gastroenterol 2014; 33:285-8. [PMID: 24715677 DOI: 10.1007/s12664-014-0445-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/22/2014] [Indexed: 02/04/2023]
Abstract
Lower gastrointestinal bleeding (LGIB) in infants and children is a difficult diagnostic problem largely due to limitations of small-bowel evaluation. Duplication cysts are rare congenital malformations with variable clinical presentation. This report describes seven children (five boys, two girls and median age 10 [1.5-124] months) with ileal duplication cysts who presented with LGIB of varying severity from stool occult blood positivity with anemia to fresh bleeding per rectum. Diagnosis was made by Tc(99m) pertechnetate scan (n-5), balloon enteroscopy (n-1), and at laparotomy (n-1). Ultrasonography and barium meal follow-through missed the diagnosis in six and three cases, respectively. All cases underwent surgery with resection of the duplication cyst and complete removal of the mucosa containing ectopic gastric tissue while preserving adequate bowel length. A good postoperative outcome with complete symptom resolution was seen in all. Enteric duplication cyst should always be considered in children presenting with occult or overt lower gastrointestinal hemorrhage, and Tc(99m) pertechnetate scan should be done prior to invasive tests like balloon enteroscopy.
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Affiliation(s)
- Srikant Pandey
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
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Li BL, Huang X, Zheng CJ, Zhou JL, Zhao YP. Ileal duplication mimicking intestinal intussusception: A congenital condition rarely reported in adult. World J Gastroenterol 2013; 19:6500-6504. [PMID: 24151372 PMCID: PMC3801322 DOI: 10.3748/wjg.v19.i38.6500] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/05/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
Intestinal duplication is an uncommon congenital condition in young adults. A 25-year-old man complained of chronic, intermittent abdominal pain for 3 years following previous appendectomy for the treatment of suspected appendicitis. Abdominal discomfort and pain, suggestive of intestinal obstruction, recurred after operation. A tubular mass was palpable in the right lower quadrant. Computed tomography enterography scan identified suspicious intestinal intussusception, while Tc-99m pertechnetate scintigraphy revealed a cluster of strip-like abnormal radioactivity in the right lower quadrant. On exploratory laparotomy, a tubular-shaped ileal duplication cyst was found arising from the mesenteric margin of the native ileal segment located 15 cm proximal to the ileocecal valve. Ileectomy was performed along with the removal of the duplication disease, and the end-to-end anastomosis was done to restore the gastrointestinal tract continuity. Pathological examination showed ileal duplication with ectopic gastric mucosa. The patient experienced an eventless postoperative recovery and remained asymptomatic within 2 years of postoperative follow-up.
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Abstract
There has been a barrier in diagnosis and treatment of small intestinal diseases for a long term. However, the development of digestive endoscopy, especially the double-balloon enteroscopy, benefits us to renew our knowledge on small intestinal diseases, such as unexplained digestive tract bleeding and intestinal tumors. Moreover, with the improvement of double-balloon enteroscopy, it has become possible for hemostasis, polyps resection, mucosal resection and stenosis cavity expanding under endoscopy. This review discusses the latest advances in the diagnosis and treatment of double-balloon enteroscopy for small intestinal diseases.
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