Hyperbilirubinemia associated with a cystic abdominal mass in a 6-week-old girl: case report

Abdominal cysts in girls are frequently observed by abdominal ultrasound (US) and are usually ovarian. In this case a cystic structure located in the right abdomen was seen in a female newborn without symptoms and was initially described as a possible ovarian cyst. Frequent US examinations showed an increase in volume and diameter, and temporary, recurring episodes of hyperbilirubinemia were observed. The US scans showed no relationship to the biliary tree. During a diagnostic laparoscopy, a cystic structure attached to the pyloric region was seen. A laparotomy revealed a cystic duplication of the stomach, which could be resected completely. The finding is discussed emphasizing the importance of clinical findings and diagnostic methods in the diagnosis and management of abdominal cystic masses in females. Accepted: 25 June 1997     

Completely isolated alimentary tract duplication in a neonate

A rare case of a completely isolated, alimentary tract duplication cyst in a 27-day-old neonate is reported. The duplication cyst was detected on antenatal fetal ultrasound and magnetic resonance (MR) imaging at 27 weeks’ gestational age. At surgery, the duplication cyst was in a retroperitoneal site with no apparent communication between the cyst and any portion of the alimentary tract. On histopathological examination, the diagnosis was a gastric duplication cyst. The patient’s postoperative course was uneventful. There have been eight cases of completely isolated duplication reported in the literature, of which seven were detected during the prenatal or neonatal period. No previous report in the English literature has described the fetal MR imaging findings of this type of duplication cyst.     

Antenatal diagnosis of pulmonary tumours: report of two cases

We report two cases of antenatal diagnosis of pulmonary tumours. In one case a bronchogenic cyst was connected with the bronchopulmonary tree and grew rapidly after birth. Thanks to the antenatal diagnosis, it was resected before any complication appeared. In the second case, congenital cystic adenomatoid malformation of the lung was associated with fetal anasarca. Initially cyst aspiration was carried out; then long-term drainage was attempted. These cases illustrate the impact of antenatal diagnosis on perinatal management.     

A case of perforated cystic duplication of the transverse colon

A 7-year-old girl presented with an abdominal cystic mass close to the pancreas. US and CT could not identify its origin. The diagnosis of duplication of the transverse colon was made at surgery. This location is rare. The differential diagnosis in this case included a pancreatic cystadenoma, a pseudocyst or a mesenteric cyst. Received: 20 March 1997 Accepted: 23 June 1997     

Ciliated hepatic foregut cyst: from antenatal diagnosis to surgery

Ciliated hepatic foregut cyst is the only ciliated cystic lesion known to occur in the liver. It is an extremely rare, benign and solitary cyst that probably arises from remnants of the embryonic foregut in the liver. We report a 16-month-old girl who underwent surgical excision of a hepatic cyst discovered during antenatal ultrasonography. Surgical exploration and excision were performed because of the uncertain aetiology of the cyst and because on postnatal follow-up US the size of the mass had increased causing extrinsic biliary obstruction. Pathology revealed a ciliated hepatic foregut cyst. This is the fourth child affected by this lesion reported in the literature, the second undergoing surgical excision, and the second with antenatal diagnosis.     

Duodenal duplication with pancreas bifidum--a case report.

Duodenal duplications constitute less than five percent of gastrointestinal duplications. Rarely, enteric duplication cysts are found in an intra- or juxtapancreatic position with or without connection to the pancreatic duct. Complete pancreaticoduodenal duplication is even less common, although there is a close relationship in the development of the two organs. We report here the case of a child with a paraduodenal cystic lesion, followed up since infancy, which turned out to be duodenal duplication cyst with a connection to Wirsung's duct of the ventral pancreas.     

Pulmonary sequestrations detected by antenatal ultrasound

We present three cases of abdominal and abdomino-thoracic extra-lobar pulmonary sequestrations detected by antenatal ultrasound (US) over a 12-month period. In addition, we briefly refer to a case previously described. A cystic mass was demonstrated in the left upper abdomen of the fetus in all four cases, with two extending into the thorax. The diagnosis was confirmed postnatally by fine-needle biopsy and later excision of the mass. In all four cases the lesion did not interfere with the pregnancy, and only one child demonstrated transient effects of mild pulmonary hypoplasia. Review of the antenatal scans showed that in each case the sequestration did not appear to grow during the pregnancy, with a relative decrease in size. Extra-lobar sequestration should always be considered in the differential diagnosis of an abdominal mass diagnosed on antenatal US, especially if cystic and extending from the abdomen through the diaphragm into the mediastinum. Although abdominal sequestrations are rare in comparison to thoracic lesions at postnatal diagnosis, they represent 21 of the 40 published series of pulmonary sequestrations diagnosed on antenatal US.     

Periampullary duodenal duplication cyst masquerading as a choledochocele

Enteric duplication cysts are rare congenital anomalies of unclear etiology. While they can occur anywhere in the gastrointestinal tract, they typically occur in the ileum or ileocecal region and very rarely in the duodenum. Here, we report a case of a periampullary duodenal duplication cyst in a 13-year-old male who presented with clinical and laboratory evidence of small bowel obstruction, hepatitis, and pancreatitis. Based on radiologic imaging, the patient was thought to have a type III choledochal cyst (choledochocele) within the duodenal lumen. Intraoperative findings and postoperative pathological evaluation, however, revealed that the lesion was a duodenal duplication cyst masquerading as a choledochal cyst. Interestingly, the duplication cyst was communicating with the common bile duct, simultaneously causing biliary and small bowel obstruction.     

Prenatal detection of isolated gastric duplication cyst

We present a rare case of gastric duplication cyst that was suspected prenatally. A routine prenatal ultrasonography (US) showed an abdominal cyst with peristalsis and a provisional diagnosis of enteric duplication was made. A healthy male infant was born at 39 weeks gestation and postnatal US identified a cyst, 5×3×2 cm in size, adjacent to the pancreas. At laparotomy, a cyst was found located in the lesser sac, but completely separated from the stomach, and partially adhered to the body of the pancreas and the crura of the diaphragm. Total excision of the cyst was successful. Histopathologic examination confirmed that the cyst wall consisted solely of normal gastric tissue with erosions. To the best of our knowledge, this is the first report of an isolated gastric duplication cyst that was detected prenatally and resected during the neonatal period.     

小儿肠重复畸形的 CT 诊断价值

目的分析小儿肠重复畸形的 CT 表现特征,探讨其诊断价值。方法回顾性分析经手术及病理检查证实的小儿肠重复畸形22例,分析其 CT 表现特点。结果22例肠重复畸形中,发生在十二指肠1例,空肠2例,回肠11例,回盲部6例,结肠2例。病理类型：肠外囊肿型18例,肠内囊肿型2例,肠外管状型2例。CT 平扫均表现为囊性肿块,22例中20例囊壁较厚,增强扫描囊壁均有强化,CT表现特征为圆形、椭圆形或管形、单房、液性低密度、厚壁囊肿。术前 CT 诊断14例,误诊6例,漏诊2例,符合率为63．6％。其中9例有其他合并症,4例并发不全性肠梗阻,2例并发感染与周围组织粘连,2例并发肠套叠,1例并发囊内出血。结论小儿肠重复畸形常常合并急腹症发病,容易误诊、漏诊。CT表现具有一定的特征性,可作为本病定位、定性诊断的重要影像学手段。     

Intrapancreatic duodenal duplication cyst with inversion of the superior mesenteric vessels: CT findings

We present a case of intrapancreatic duodenal duplication cyst and inversion of the superior mesenteric vessels. CT findings of this association are discussed. Received: 13 March 2000 Accepted: 26 June 2000     

Relapsing pancreatitis in a child duplication in an aberrant pancreatic lobe

An aberrant pancreatic lobe associated with an enteric duplication cyst is a rare cause of relapsing pancreatitis in childhood. We present an 8-year-old boy with relapsing pancreatitis caused by this rare congenital foregut anomaly. The computed tomography (CT) findings revealed an unusually long segment of aberrant pancreatic lobe arising from the pancreatic neck, projecting anteriorly at a distance to a cystic duodenal duplication and appearing as an inflammatory mass. There has been no previous report of this unusual appearance on CT. Appreciation of the relevant anatomy provided by CT led to the successful management of this surgically-treatable cause of relapsing pancreatitis. Accepted: 12 April 1999     

Infected duodenal duplication with unusual clinical and radiological manifestations: a case report

Infected cystic duplication of the duodenum is an unusual lesion. We report a case in which pre-operative MR imaging revealed a huge multicystic mass masquerading as a cystic lymphangioma or mesenteric cyst. The differential diagnosis of this unusual appearance is discussed. Received: 12 January 1998 Accepted: 19 January 1998     

Antenatal rupture of a diverticular rectal duplication with neonatal perineal fistulization

A cystic pelvic malformation was found in a fetus on antenatal sonography (US) at 26 weeks of gestational age that was no longer present 3 weeks later on control US. The male child presented at birth with a right-sided perineal mass that fistulized with meconial drainage. A radiopaque enema showed a low posterior rectal fistula filling a poorly delineated pouch. Surgery performed through a posterior sagittal approach allowed identification and closure of the fistula and pouch drainage. The diagnosis of a diverticular rectal duplication was considered, although no intestinal lining was observed macroscopically or histologically. The child's anorectal function was normal after a 20-month follow-up. Labeling of the malformation and embryological hypotheses are discussed since the case does not fulfill all the criteria of an intestinal duplication. Surgical techniques are discussed, with an emphasis on the sagittal posterior approach. Accepted: 15 March 1997     

The management of choledochal cysts in the newborn

Choledochal cysts are now being diagnosed before birth on routine maternal sonography (US). There is no report in the literature outlining the management of newborns with choledochal cysts, many of whom are asymptomatic. Our study details the diagnosis, treatment and outcome of six such children, four girls and two boys. Five had antenatal US revealing cystic abdominal masses. One had intermittent vomiting and US suggested a choledochal cyst. Four of six had normal serum bilirubin levels; two had elevations. In five babies the choledochal cyst was correctly diagnosed from the preoperative studies; in one the preoperative diagnosis was an ovarian cyst. The children underwent an operation at an average of 6 weeks of age (range 5 days to 17 weeks). At exploration, cholangiography showed Alonso-Lej type I cysts in all cases. Treatment consisted of resection of the cyst with Roux-en-Y choledochojejunostomy in five and with a valved jejunal choledochoduodenal conduit in one. In no case was the dissection of the choledochal cyst off the portal vein and hepatic artery difficult. There were no intra- or early postoperative complications. Mean hospital stay was 8 days (range 5 to 9 days). Presently, all 6 patients have normal bilirubin levels at an average length of follow-up of 35 months (range 16 to 70 months) after operation. We conclude that operative treatment of choledochal cysts in early infancy, even in asymptomatic children, is safe and effective and may prevent serious complications later in life.     

Coincidence of a ductal pancreatic cyst and a gastric duplication cyst: a case report.

We report a case of two abdominal cystic formations in an 18-month-old girl. Laparotomy was performed with surgical removal of both cysts. The cysts were connected by a fibrous bridge. Histology revealed a gastric duplication cyst and a ductal pancreatic cyst originating from an aberrant pancreatic lobe. No fistula was found either to the alimentary tract or in either of the cysts. The clinical picture and treatment are described and compared to findings in the literature.     

Antenatal small-bowel volvulus without malrotation: ultrasound demonstration and discussion of pathogenesis

We present a case of volvulus without malrotation in a twin fetus where serial antenatal US assisted in the diagnosis and ensured prompt postnatal surgical treatment. When a fetal subumbilical intestinal mass is seen, changing its echogenicity from complex to cystic, and associated with progressive proximal small-bowel obstruction and/or bowel perforation, small-bowel volvulus should be included in the differential diagnosis.     

Duodenal duplications. Clinical characteristics, embryological hypotheses, histological findings, treatment.

BACKGROUND: The aim of this study was to analyse different clinical aspects and embryologic hypotheses of duodenal duplications. METHODS: Duodenal duplications occurring since 1995 were recorded. The age of the children at the time of diagnosis, the sex, location of the duplication, type of mucosa, clinical signs, associated lesions, and the type of surgical intervention were defined. RESULTS: We identified 5 patients (3 girls and 2 boys) who presented with histological or intraoperative findings of duodenal duplication. Their ages ranged from 4 days to 9 years, with the exception of two prenatal diagnoses. Three children were symptomatic: high intestinal obstruction (1 case), digestive bleeding (2 cases). In 1 case we found a palpable abdominal mass and 1 case was completely asymptomatic (prenatal detection). The abnormality was located on the duodenal concavity, originating from the third part in 2 cases and from the second part in 3 cases. All cases were non communicating types, 4 of which were cystic duplications and 1 was a tube-like variety. The epithelial lining was duodenal mucosa in all patients, but gastric heterotopies were identified in 2 cases. We performed two complete resections and 3 intraduodenal derivations. The outcome was uneventful in 5 cases with an average follow-up of 2 years. CONCLUSION: Duodenal duplications are rare malformations with several anatomical varieties. The preferred treatment for duodenal duplications is complete removal when the location allows it without endangering nearby anatomical structures.     

Mesothelial cyst of the liver in a neonate

Mesothelial cysts are very rare congenital cystic lesions that are derived from coelomic remnants. We report a neonate with a mesothelial cyst of hepatic origin. On routine antenatal ultrasound study, an intra-abdominal mass was seen. After birth, the cystic lesion’s size increased to 8 cm and became symptomatic. Surgical resection was performed. Preoperative diagnostic imaging studies, including CT and MRI, did not identify the etiology, but the cyst appeared to be of hepatic origin. Intra-operatively, the cystic lesion was confirmed to have originated from the liver. Based on immunohistological analysis, the final diagnosis was mesothelial cyst of the liver.     

Neonatal intestinal occlusion due to duodenal duplication in association with malformed gallbladder sludge

Duodenal duplications are rare observations which can be diagnosed during early pregnancy via US scan. In the neonate they are often cause for intestinal occlusions. Surgical treatment can be limited by the duplication's anatomical interrelationships with adjacent organs. Biliary sludge is an uncommon finding in the first year of life, and can readily regress spontaneously. The association between duodenal duplication and sludge has never been described in the literature in the neonatal period. Here, for the first time, we report on the case of a newborn infant with cystic duplication of the duodenum associated with sludge in a misshapen gallbladder.