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| CASE REPORT |
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| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 115-117 |
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Computed tomography findings in a case of gastric duplication cyst
Siddharth Tewari1, Niharika Prasad2
1 Department of Radiodiagnosis, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
2 Department of Radiodiagnosis, IOCL, Barauni Refinery Hospital, Barauni, Bihar, India
| Date of Submission | 17-Nov-2022 |
| Date of Decision | 13-Dec-2022 |
| Date of Acceptance | 25-Mar-2023 |
| Date of Web Publication | 16-May-2023 |
Correspondence Address:
Dr. Siddharth Tewari
Junior Resident (PGY3), Department of Radiodiagnosis, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jihs.jihs_16_22
Gastric duplication cysts comprise a rare congenital anomaly constituting 8% of total gastrointestinal tract duplications. They may be associated with complications, or may be discovered incidentally. This case report illustrates the same, in which an adult female had presented with vague abdominal complaints. Subsequently, a computed tomography scan had revealed a cystic lesion adjacent to the stomach. She was treated surgically.
Keywords: Complications, cyst, differential diagnosis, duplication, gastrointestinal
How to cite this article:
Tewari S, Prasad N. Computed tomography findings in a case of gastric duplication cyst. J Integr Health Sci 2022;10:115-7 |
| Introduction | |  |
Duplication cysts can occur in any part of the gastrointestinal tract and are described according to the viscus that they are in close proximity with.[1] They are usually asymptomatic. Gastric duplication cysts are most commonly seen close to the greater curvature.[2] They present with gastrointestinal bleed due to ulceration, abdominal pain, vomiting, or a mass.[2],[3] The typical computed tomography (CT) imaging findings along with a brief discussion has been mentioned in this case report.
| Case Report | | |
A 42-year-old female presented with a complaint of heartburn of 1-month duration. She did not have any history of vomiting, diarrhea, fever, weight loss, hematemesis, or melena. She did not have any abdominal surgery in the past. Her routine blood investigations and ultrasound of the abdomen did not reveal any abnormality. A CT of the abdomen with oral and intravenous contrast was performed.
A well-defined thin-walled, homogeneous, cystic lesion (0–20 HU) of size 61 mm × 57 mm × 46 mm was seen in the left posterolateral perigastric region, adjacent to the gastroesophageal junction [Figure 1]. | Figure 1: Axial image of noncontrast CT abdomen shows a homogeneous, cystic lesion in the perigastric region, adjacent to the gastroesophageal junction. It did not show any calcifications. CT: Computed tomography
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The cyst showed homogeneous wall enhancement. It did not have any internal solid components or septations or calcifications within it [Figure 2]. | Figure 2: Axial image of CECT abdomen in the arterial phase shows no enhancing solid components or septations within the cyst. CECT: Contrast-enhanced computed tomography
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The left adrenal gland was visualized separately from the cyst [Figure 3]. | Figure 3: Axial image of CECT abdomen in the arterial phase shows a normal left adrenal gland, which is separate from the above-mentioned cyst. CECT: Contrast-enhanced computed tomography
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The cystic lesion was seen to cause extrinsic compression and mild inferior displacement of the upper pole of the left kidney, superior and anterior displacement of the posteroinferior stomach wall, and lateral displacement of the upper pole of the spleen. However, the fat planes with adjoining organs were maintained [Figure 4]. | Figure 4: A sagittal image of the CECT abdomen in the arterial phase shows the anatomical relationship of the cyst with the stomach, the spleen, and the left kidney. CECT: Contrast-enhanced computed tomography
Click here to view |
A diagnosis of a gastrointestinal duplication cyst was made, likely gastric duplication cyst. Laparoscopic resection of the mass was done. On histopathological evaluation, it was confirmed to be a gastric duplication cyst with mucosal and submucosal architecture similar to that of the stomach. No evidence of inflammation/dysplasia/heterotopic tissue was noted.
| Discussion | | |
Gastrointestinal tract duplication cysts in adults are quite rare. The most common site is the ileum, followed by the esophagus, jejunum, colon, stomach, and appendix. The criteria which must be met for diagnosis include.[1],[2],[3]
- Continuity of cyst wall within the stomach
- Coat of shared smooth muscles around cyst
- Cyst and stomach share common blood supply
- Cyst has an epithelial lining of the gastrointestinal tract.
There are numerous hypotheses expounding how duplication cysts form, such as incomplete twinning, ischemic episodes in utero, a persistent embryological diverticulum, or abnormal recanalization of the digestive tract.[2]
Only 8% of gastrointestinal tract duplications are gastric duplications.[2] While gastric duplication cysts typically occur along the larger curvature, duplication cysts of the ileum are typically found along the mesenteric border. Gastric duplication cysts come in two forms: Cystic when the lumen is not contiguous with the stomach lumen and tubular when the lumen is continuous with the stomach lumen. Most gastric duplications (>80%) are cystic and do not communicate with the stomach lumen.
The hallmark of gastric duplication cyst on histopathology is that any type of gut tissue may be seen lining the cyst (e.g., gastric mucosa, colonic mucosa, and jejunal mucosa).Heterotopic tissue such as ectopic pancreatic tissue and respiratory tract epithelium have been described.[2],[3]
Symptoms, if present can be in the form of abdominal fullness, vomiting, gastrointestinal bleed, and abdominal pain. A rare presentation of rectal bleeding in an infant has been described previously in the literature.[4] A case of gastrointestinal duplication cyst causing gastric outlet obstruction in adult was reported in Pakistan[5]
Gastric duplication cysts appear as well-defined cystic lesions on ultrasonography, however, this modality has a low sensitivity for their diagnosis. An inner hyperechoic mucosal lining with an outer hypoechoic muscle layer (“double wall sign”) is very characteristic. Internal echoes and septations may be present. CT is the investigation of choice, and usually shows a cystic lesion adjacent to the greater curvature of the stomach. On magnetic resonance imaging the lesions are T2 hyperintense but may show variable signal intensity in case of complicated cysts.[5],[6] Endoscopic ultrasound has also been described to be a very good modality of investigation and is superior to conventional abdominal ultrasound in demonstrating the cyst wall.[6]
Differential diagnoses include – pancreatic pseudocysts, other enteric duplication cysts, abscesses, mucinous cystadenoma of the pancreas, gastrointestinal stromal tumors, and cystic adrenal lesions. Important differential diagnosis and differentiating features are provided in [Table 1]. Few authors have described a case of gastric duplication cyst mimicking a cystic lymphangioma.[7],[8] The development of malignant transformation is rare. Adenocarcinoma, squamous cell carcinoma, neuroendocrine carcinoma, leiomyoma, and gastrointestinal stromal tumor have been reported in literature.[9] | Table 1: Gastric duplication cyst: Differential diagnosis (adapted from Gandhi et al.[9])
Click here to view |
Complete surgical removal with resection of the common wall between the cyst and the stomach has been advised to prevent recurrence and complications.[8],[9]
| Conclusion | | |
So when evaluating a cystic lesion adjacent to the wall of the stomach, gastric duplication cyst should be in the differential list. Imaging alone cannot provide a definitive diagnosis and histopathological analysis should be done for confirmation. Due to the possible complications and the risk of malignant transformation, surgical resection remains the mainstay of treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Singh JP, Rajdeo H, Bhuta K, Savino JA. Gastric duplication cyst: Two case reports and review of the literature. Case Rep Surg 2013;2013:605059.  |
| 2. | Bennani A, Miry A, Kamaoui I, Harroudi T. Gastric duplication cyst in an adult with autoimmune hemolytic anemia: A case report and review of the literature. J Med Case Rep 2018;12:380. |
| 3. | Kim SM, Ha MH, Seo JE, Kim JE, Min BH, Choi MG, et al. Gastric duplication cysts in adults: A report of three cases. J Gastric Cancer 2015;15:58-63. |
| 4. | Surridge CA, Goodier MD. Gastric duplication cyst: A cause of rectal bleeding in a young child. Afr J Paediatr Surg 2014;11:267-8. [ PUBMED] [Full text] |
| 5. | Khan Khattak MA, Nisar MU, Sikander S, Akthar N. Gastric duplication cyst: A rare congenital anomaly causing gastric outlet obstruction. J Ayub Med Coll Abbottabad 2019;31:466-8. |
| 6. | Abdalkader M, Al Hassan S, Taha A, Nica I. Complicated gastric duplication cyst in an adult patient: Uncommon presentation of an uncommon disease. J Radiol Case Rep 2017;11:16-23. |
| 7. | Xv FY, Sun A, Gan Y, Hu HJ. Gastric duplication cyst mimicking large cystic lymphangioma in an adult: A rare case report and review of the literature. World J Clin Cases 2019;7:2087-93. |
| 8. | Rao TN, Parvathi T, Suvarchala A. Omental lymphangioma in adults-rare presentation report of a case. Case Rep Surg 2012;2012:629482. |
| 9. | Gandhi D, Garg T, Shah J, Sawhney H, Crowder BJ, Nagar A. Gastrointestinal duplication cysts: What a radiologist needs to know. Abdom Radiol (NY) 2022;47:13-27. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1]
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