Communicating tubular ileal duplication cyst

A six year old boy presented with right iliac fossa pain and was found to have a palpable lump in the right lower quadrant. Ultrasound showed a complex cystic mass in the right lower abdomen, raising the suspicion of an appendicular lump. Surgical exploration confirmed the presence of a tubular duplication cyst of the ileum, which was resected succesfully.

Enteric duplication cysts (EDCs) are seen in 0.2% of children (1 in 4500 live births) and show slight male preponderance.^[1] Frequently observed in the terminal ileum, EDCs have a gastrointestinal (GI) mucosal lining (ectopic gastric tissue in 20–30%), a layer of smooth muscle tissue, and a common blood supply with the GI tract [Figure 1]. EDCs characteristically arise from the mesenteric border of the intestine and can be cystic (Type 1 seen in 79% of cases) or tubular (Type 2 seen in 21% of cases).^[2] Prenatal ultrasound can identify around 20–30% of EDCs. About 80% of EDCs present within first 2 years of life with abdominal pain, vomiting and abdominal distension, asymptomatic palpable mass or rectal bleeding. Ultrasonography demonstrates a hollow structure with anechoic content, an intimal connection with the nearby intestine (“Y-configuration” of the common muscular wall), and “gut sign” (hyperechoic mucosa and hypoechoic smooth muscular tissue). Surgical treatment entails complete excision with closure of defect or segmental resection with anastomosis.

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Figure 1:

(a) Ileal duplication cyst in a 6 year-old boy with palpable lump in the right lower quadrant (b) Surgical exploration confirmed the presence of a tubular EDC with well-developed communication with the ileal loop.

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