Gastric duplication cysts – A rare cause of adult gastric outlet obstruction!
Gastric duplication cysts are a rare anomaly which can occur anywhere from the oral cavity to the rectum. However, gastric cysts are quite uncommon and it is even rarer to find these in the antrum or pre-pyloric region of the stomach. On the other hand, the ileum is the most common site. Here is a case presentation of an otherwise healthy 29-year-old male patient who presented with complaints of nausea, vomiting, and unintentional weight loss of 20 pounds.
On examination the patient was afebrile. His vitals were normal too. Abdominal examination revealed a soft, non-tender, and non-distended abdomen.
Serology revealed:
- Hypokalemic
- Hypochloremic
- Metabolic alkalosis
The clinical picture suggested a diagnosis of gastric outlet obstruction.
Imaging:
The doctors performed abdomino-pelvic Computed Tomography (CT) scan, which revealed a 3.5 × 4.9 cm cyst proximal to the pylorus. The CT scan findings suggested a gastric duplication cyst which caused the gastric outlet obstruction. Gastric duplication cysts comprise 4% to 9% of all intestinal duplication cysts. These can be congenital. However, in adults, these are a rare and incidental finding.
Endoscopy showed a large pre-pyloric mass. However, it did not show any mucosal abnormality or luminal connection. As a result, the pre-pyloric mass was considered to be the most probable cause of gastric outlet obstruction.
During endoscopy, biopsy samples were taken from the antrum which showed chronic inflammation and mild foveolar hyperplastic changes.
Therefore, with the clinical manifestations suggesting gastric outlet obstruction and the imaging studies suggestive of a duplication cyst, the treating doctors decided to operate the patient. The patient underwent robotic-assisted laparoscopic distal gastrectomy with Billroth 2 gastrojejunostomy for a suspected gastric duplication cyst.
The final histopathological evaluation revealed features consistent with a gastric duplication cyst (5.2 × 4.0 × 4.0 cm) not communicating with the gastric lumen.
Are the duplication cysts malignant?
Malignant degeneration is rare in these cysts, but, yes, there is a risk!
How soon can the duplication be diagnosed?
Typically, the gastric duplications exhibit symptoms during childhood. In fact, 67% of the cases are diagnosed within the first year of life. About 25% or less get discovered after the age of 12. Whereas in adults, the gastric duplication cysts come to light incidentally on imaging or intra-operatively.
What is the treatment of gastric duplication cysts?
Complete cyst resection is the treatment of choice, either laparoscopically or via open surgery.
References:
Doepker MP, Ahmad SA. Gastric duplication cyst: a rare entity. J Surg Case Rep. 2016;2016(5):rjw073. Published 2016 May 5. doi:10.1093/jscr/rjw073
Shah SK, Mehta SS, Bajwa KS (2017) Gastric Duplication Cyst as an Unusual Cause of Gastric Outlet Obstruction in an Adult. Clin Med Img Lib 3:072. doi.org/10.23937/2474-3682/1510072
