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Duplication cyst

From Surgopaedia

GI duplication cyst

Epidemiology

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A rare congenital malformation. 1 in 4500.

Mostly symptomatic within first two years of life

Usually not communicating with bowel lumen, but can fistulate

Most common in ileum

Pathophysiology

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  • An epithelial lining corresponding to part of the gut
  • Defined layer of smooth muscle
  • Close approximation with part of the gut, including possibly sharing a common wall

Classify based on location

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  • Foregut duplication cyst
    • Oesophageal
    • Bronchogenic
    • Neurogenic
  • Midgut
  • Hindgut
    • A.k.a. retrorectal cystic hamartoma
    • Vestige of embryonic hindgut

Differential diagnosis

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  • Meckel's
  • Congenital segmental intestinal dilatation
  • Other intra-abdominal cystic lesions - mesenteric, omental, choledochal, ovarian
  • Pre-sacral masses
  • Intra-thoracic cysts - pericardial, thymic

Investigation

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  • USS is good for foregut cysts
  • CT picks them up, but not specific
  • MRI especially good for hindgut cysts
  • Technetium-99m pertechnetate scan will show presence of gastric mucosa, which is there in many cysts, especially midgut

Complications

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  • Intussusception
  • Malignant transformation
  • Volvulus
  • Haemorrhage

Management

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  • Generally excised
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