Enteric duplication cysts, sometimes simply called duplication cysts, are rare congenital malformations of the gastrointestinal tract. They most frequently occur in. Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts. multiple opacities with a calcium density in midabdomen INTESTINAL DUPLICATION Includes: Duplication intestinale Intestinale Duplikation Duplicación.
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Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts.
Endoscopic ultrasound EUS has been widely used as a modality for the evaluation and diagnosis of duplication cysts. EUS is the diagnostic tool of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. The question of whether or not to perform EUS-fine needle aspiration EUS-FNA on a lesion suspected of being a duplication cyst is controversial as these lesions can become infected with significant consequences, although EUS-FNA is often intextinale to obtain a definitive diagnosis untestinale to rule out more ominous lesions.
This manuscript will review the literature on duplication cysts throughout the body and will also focus on the role of EUS and FNA with regards to these lesions. Foregut duplication cysts are categorized on the basis of their embryonic origin into esophageal, bronchogenic, and neuroenteric cysts. They may be contained within the gastrointestinal tract wall or extrinsic to it.
Peristalsis in a juxta-enteric cyst is specific for a duplication cyst and can be a diagnostic feature. The prevalence of esophageal duplications cysts is 0. Esophageal duplication cysts have a double layer of surrounding smooth muscle, are lined by alimentary squamous or enteric epithelium, and are either attached to esophagus in a paraesophageal or intramural fasion.
Enteric duplication cyst – Wikipedia
Rare symptoms such as cardiac arrhythmia, retrosternal and thoracic back pain, cyst ulceration and bleeding, or cyst rupture with secondary mediastinitis have also been reported.
On routine endoscopy, esophageal duplication cysts can be identified via extrinsic compression of the lumen with normal appearing overlying esophageal mucosa. Endoscopically, these lesions may be indistinguishable from a intetinale, leiomyoma, a gastrointestinal stromal tumor GISTor other submucosal lesions.
On EUS, esophageal duplication cysts will often appear as a periesophageal duplicatiion hypoechoic mass with multi-layered wall and well-defined margins, although sometimes the lesion can manifest as an anechoic cyst if considerable central fluid is present[ 1 ] [ Figure 1 ]. Endoscopic view of an esophageal duplication cyst in a 9-year-old male with dysphagia.
Note the normal overlying mucosa and the narrowing of the esophageal lumen. The lesion has a multi-layered wall structure and areas of anechoic fluid as well as some echogenic material seen on the left side of the lesion.
EUS-fine needle aspiration was deferred. The lesion was surgically resected. The role of EUS-guided fine needle aspiration FNA in the diagnosis of esophageal duplication cysts, and duplication cysts in general, has been controversial. Endoscopic ultrasound-guided FNA is usually reserved for lesions of indeterminate appearance, lesions that are concerning for malignancy, and lesions that are atypical in appearance for duplication cysts.
It should be noted that many duplication cysts can have an unusual appearance and can mimic other pathologic entities, including the malignant adenopathy.
Even expert endosonographers can mistake a duplication cyst for a more ominous lesion, and aspirating a lesion of concern should not be considered a breach of the standard duplixation care. Concerns regarding causing an adverse event following EUS-guided FNA of esophageal duplication cysts are well founded. The infected esophageal duplication cyst duplicstion to acute development and infection of a thoracic aorta pseudoaneurysm.
This patient subsequently underwent thoracotomy with cyst resection. In asymptomatic cases, surgery can be considered as the cyst could develop ulceration or perforation and the short-term postoperative outcome in these patients has been excellent. Another treatment strategy is observation in asymptomatic individuals. These authors advocated EUS surveillance over surgery in asymptomatic patients, although the cost implications of such an approach have not been formally studied to date.
Histologically, the cyst wall can consist of mucosa, subepithelial connective tissue, a layer of smooth muscle, and an outer fibrous capsule. The mucosa is typically lined by gastric foveolar epithelium, but most of the cystic wall is lined by a pseudostratified columnar ciliated epithelium.
Sometimes small intestinal or colonic mucosa can also be found. The origin of gastric duplication cysts remains uncertain. Khoury intesginale Rivera reported two cases where the gastric duplication cysts appear to originate from a respiratory diverticulum which arises from the ventral foregut.
Patients with gastric duplication cysts can be asymptomatic but can also develop symptoms such as diffuse abdominal pain, epigastric pain, vomiting, weight loss, gastric outlet obstruction, ulcerated antral mass, or failure to thrive. On EUS, gastric duplication cyst can appear as a hypoechoic lesion with a heterogeneous internal echotexture and regular margins. Gastric duplication cysts can be contiguous with the muscularis propria of the gastric wall.
This study did not describe the wall appearance of the cyst in detail. The role of Inteestinale in establishing the diagnosis remains controversial. Some authors such as Seijo et al. Symptomatically, patients with bronchogenic duplication cysts can present with dysphagia, chest pain, cough, shortness of breath, or abdominal pain. On EUS, these lesions often appear as round or oval lesion with a thin outer intestianle and located adjacent to the intestinake esophagus with well-defined endosonographic borders.
Computed tomography scan image of a large mediastinal cyst in a year-old man with chest discomfort. Note that the cyst appears to duplicatino a fluid as well as a suggestion of solid material that does not enhance with contrast.
The lesion is seen to contain anechoic fluid, as well as a hyperechoic structure with finger-like projections.
The lesion did undergo EUS-fine needle aspiration and revealed bronchogenic elements and mucus with a copious debris. Fine needle aspiration revealed bronchogenic elements consistent with a benign bronchogenic duplication cyst.
When aspirated by EUS-FNA, cytology can reveal cellular debris, hemosiderin laden macrophages, ciliated columnar cells, and goblet cells. Two of them involved patients with bronchogenic cyst who received pre and postprocedure prophylactic antibiotics.
Ultrasound evaluation of the enteric duplication cyst: the gut signature
These two patients went on to develop infected cysts. One was resected with video-assisted thoracoscopy and the other one with thoracotomy.
With regards to treatment, surgical enucleation is the treatment of choice in symptomatic cases. In asymptomatic cases, surgical resection has been suggested due to the rare development of complications or malignancy, but many of these lesions can be safely observed.
Small bowel duplication cysts can be associated with all three small bowel subtypes: Duodenal, jejunal, and ileal. Jejunal duplications are the most common, followed by ileal and duodenal duplications. In general, the wall of small bowel duplication cysts can contain two-mucosal layers sharing a common muscle layer. Jejunal duplication cyst consists of submosa, muscularis propria, and are lined with jejunal mucus glands.
Similarly, ileal duplication cyst consists of submosa, muscularis propria, and are lined with ileal mucus glands and can contain heterotopic gastric mucosae. The lesion was discovered incidentally on a computed tomography scan performed to evaluate for renal stones.
The lesion manifests as a multi-layered cystic structure with the cyst muscularis propria communicating with the duodenal muscularis propria, as well as what appears to be a mucosal prominence.
The patient declined surgical resection and has undergone serial EUS exams without interval change. Most duodenal duplication cysts are located in the second or third portion of the duodenum. Patients with small bowel duplication cysts can present with a variety of symptoms including vomiting and abdominal pain.
The patient underwent small bowel resection and duodenotomy with uneventful recovery. Her symptoms had resolved following surgical resection. Duodenal cysts can cause other complications such as pancreatitis, infection, weight loss, and GI bleeding from ulceration cuplication the ectopic gastric mucosa within the cyst.
Rarely, malignant transformation can occur in the setting of gastric mucosa heterotopia within the duplication cyst. On EUS, duodenal duplication cysts can have a layer wall consistent with cyst of intestinal origin, and the cyst’s muscularis propria can intestknale continuous with the muscularis propria of the duodenum. Regarding the treatment, duodenal cysts are intestihale treated with surgical resection, although endoscopic treatment has been reported especially in cases where the duplication is in close proximity to the major duodenal papillae.
Treatment of asymptomatic duodenal cysts remains controversial. This has been seen as an argument for resection of ileal duplication cysts. Colonic duplication cysts represent 6. They can contain intestinalle least one outer muscular layer with an inner gastrointestinal mucosal lining.
Colonic duplication cysts can also contain well-organized layers of smooth muscle with intimate attachment of the common wall to the colon and fibrosis, inflammatory cells, lymphoid aggregates, necrosis, and calcification. Colonic duplication cysts can be located anywhere in the large intesting. Gastrointestinal bleeding can occur intesfinale ectopic gastric mucosa ulcerates and erodes into adjacent organs or vessels. It should be noted that some cysts lack a well-organized layered wall due to some degree of involution or degeneration.
The submucosa may be difficult to see and has no universally agreed upon appearance. Peristalsis of the cyst wall has also been reported on EUS. Endoscopic view of an extrinsically compressing cystic lesion adjacent to the rectum in a year-old female.
The lesion was discovered during a staging computed tomography scan for uterine cancer. The lesion manifests as a complex, multi-layered structure with a complex luminal contour. Endoscopic ultrasound-fine needle aspiration was deferred given the appearance, and the patient declined any intervention on the lesion given that she had a concurrent cancer diagnosis.
Regarding the treatment, some authors recommend routine resection of asymptomatic colonic duplication cysts due to the potential for perforation, bleeding, obstruction, and malignant degeneration.
Gastrointestinal duplication cysts are rare congenital lesions in adults. Some patients are asymptomatic while others can present with abdominal pain, bleeding, and abdominal pain.
EUS can offer an accurate diagnosis of duplication cysts. EUS-FNA allows high-resolution morphologic analysis as well as sampling and microscopic examination of cyst contents; it can also lead to duplication cyst infection with associated complications despite pre and postprocedural antibiotics in some patients. EUS-FNA of duplication cysts can carry an increased risk of complications, but may be warranted to obtain a definitive diagnosis and to rule out more serious pathology.
Once the diagnosis of duplication cyst is established, treatment can vary depending on the presence of symptoms. In symptomatic patients, surgical resection is often the choice for symptom relief. In asymptomatic patients, surgical resection is controversial. While some authors advocate for resection due to possible malignant degeneration of the duplication cyst, others have advocated for observation. Since there have been case reports of stable duplication cysts on EUS surveillance, this may be a suitable method of outpatient follow-up and surgical resection can be considered if patient develops symptoms.
In any case, surgical versus nonsurgical management of asymptomatic duplication cysts is likely to remain controversial until we understand more about the time course and risk factors associated with their malignant degeneration.
National Center for Biotechnology InformationU. Journal List Endosc Ultrasound v.