Gastric Duplication Cysts

0
Gastric duplication cyst

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.

 Computed Tomography (CT) of the abdomen/pelvis: Arrow is showing a cyst in the pre-pyloric antral area with associated gastric dilation suggestive of gastric outlet obstruction.

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.

Endoscopic finding

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

World Hepatitis Day 2021
Previous articleAcute Pulmonary Embolism In COVID-19
Next articleSouth African Coronavirus Variant Found in UK
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

LEAVE A REPLY

Please enter your comment!
Please enter your name here