Successful endoscopic treatment of an esophageal duplication cyst

Duplication cysts of the gastrointestinal tract are rare, particularly in adults. Endoscopic minimally invasive treatment is still a challenging approach even in the endoscopically accessible sections of the gastrointestinal tract. In a 25-year-old patient suffering from dysphagia, an endoscopy and subsequent endosonography revealed a spherical duplication cyst in the lower third of the esophagus, which prompted us to puncture the cyst and subsequently to perform a fenestration (marsupialization; diameter 1 cm) in the anterior wall of the cyst, resulting in permanent drainage of the cystic fluid. Because of the recurrent complaints of the patient after 6 weeks, the anterior wall of the duplication cyst, the former esophageal wall, was partially resected, resulting in a permanent 4-cm opening including the cystic cavity into the esophageal lumen. Thereafter, there were no further complaints from the patient and the findings in the follow-up endoscopy were normal. A successful endoscopic intervention for this type of gastrointestinal duplication cyst is described for the first time. The minimally invasive resection of the anterior wall of the esophageal duplication cyst, simultaneously with the former regular wall at this segment of the esophagus, resulted in permanent inclusion of the cystic cavity into the esophageal lumen with no disadvantageous passage of fluid and food through the lower esophagus or changes in the former cystic epithelium. This method is considered to be feasible and a reasonable treatment alternative to the more invasive surgical approach.     

Acute ruptured esophageal duplication cyst

A 32-year-old man presented acutely with a ruptured esophageal duplication cyst. This is a rare complication from an unusual congenital condition. The case describes his clinical presentation, radiological investigation and surgical management. The pathology of the excised specimen is described and a literature review concludes that complete surgical resection of an esophageal duplication is always recommended, even if the condition is asymptomatic. Conventionally this is achieved via a thoracotomy, however thoracoscopic-assisted excision may have a role.     

Congenital cystic adenomatoid malformation complicated by esophageal duplication cyst in a 6-month-old girl

We report a case of congenital cystic adenomatoid malformation (CCAM) complicated by an esophageal duplication cyst in a 6-month-old girl. The patient presented with recurrent pneumonia. Magnetic resonance imaging revealed two cystic lesions in the upper and lower lobes of the right lung. After cystectomy, histopathological investigation revealed that the lower cyst was a CCAM Type I, and the upper cyst was an esophageal duplication cyst. The coexistence of these complex anomalies supports the concept that the esophageal duplication cyst is one entity of a broad spectrum of developmental abnormalities caused by abnormal budding of the primitive foregut.     

An infected esophageal duplication cyst in a patient with non-Hodgkin''s lymphoma mimicking persistent disease

Differentiation of mediastinal cysts appearing as soft-tissue attenuation masses on computed tomography (CT) scans from malignant mediastinal masses is difficult. We report a patient with non-Hodgkin's lymphoma, who was considered to have persistent disease in the posterior mediastinum based on CT scans. However, endoscopic ultrasound (EUS) demonstrated a paraesophageal, fluid-filled cyst with echodens inclusions and no evidence of any solid component. EUS-guided fine-needle aspiration (FNA) revealed mucous, epithelial and inflammatory cells, and additionally candida albicans was cultured. Based on these findings and constant size during follow-up, the diagnosis of an infected esophageal duplication cyst was made. Thus, this report further demonstrated the impact of EUS and EUS-FNA for management of posterior mediastinal cystic lesions in selected cases.     

Gastric duplication cyst: Evaluation by endoscopic ultrasonography and magnetic resonance imaging

Endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) are becoming popular methods for examining tumorous lesions along the upper gastrointestinal tract. Though duplication cysts are uncommon. EUS findings from gastric duplication cysts have accumulated and proven very useful for preoperative diagnosis. There have been few reports, however, concerning MRI findings from these cysts. We report herein the case of a 25-year-old man with a gastric duplication cyst. EUS demonstrated a cystic mass adjacent to the fourth layer of the stomach wall. MRI revealed a cyst containing low signalintensity fluid and high signal-intensity fluid separated by levels. In addition to the characteristic findings from preoperative examinations, the unique histological findings from the cyst are also described.     

Thoracoscopic resection of esophageal duplication cysts

Esophageal duplication is a rare congenital esophageal disorder. Surgical excision is the standard treatment for symptomatic esophageal duplication cysts. Traditionally, the resection is accomplished via thoracotomy; however, a minimally invasive approach is possible, avoiding the long hospital stay, the discomfort and the long recovery time due to a thoracotomy. The authors describe two cases of esophageal duplication resected via a left thoracoscopic approach.     

Robotic assisted thoracic surgery for resection of an esophageal cyst

Many centers around the world are now developing robotic surgical programs. The benefit of robotics, particularly in those centers where there is already expertise with minimally invasive surgical techniques, is unclear. We present the case of a 58-year-old man presenting with an esophageal cyst. This was removed using a robotic assisted, VATS (video assisted thoracic surgery) approach. The technical details of the procedure are described. Additionally, a discussion of the relative merits of using a robotic rather than a standard minimally invasive approach is discussed. In a procedure such as the case described, the critical parts of the procedure are focused within a small operative field. We believe that the articulating instrumentation and the 3-dimensional magnified view provided by the robot offers significant advantages over a standard VATS approach.     

Gastric duplication cyst: A rare endosonographic finding in an adult

Cystic lesions located in the gastric wall are a rare finding in endosonography of the gastrointestinal tract. Compared to all forms of benign and malignant tumours of the stomach, gastric duplication cysts are an uncommon anomaly – especially in adults. We report on a 59-year-old woman suffering from intermittent abdominal pain, weight loss and nausea. A gastric duplication cyst was identified by endoscopic ultrasound (EUS), but malignancy was excluded by EUS and fine-needle aspiration histology. Because of continuously increasing abdominal complaints, surgery was performed with partial resection of the gastric corpus and splenectomy. Gross anatomy and histology showed a gastric cyst measuring 150 mm in maximum diameter with no evidence of malignancy or inflammation. Following surgery, the patient's condition recovered fully.     

Recurrent acute pancreatitis secondary to a duodenal duplication cyst in an adult. A case report and literature review

Duodenal duplication cysts are rare congenital abnormalities that are most commonly diagnosed in infancy and childhood. However, in rare cases, the lesion can remain asymptomatic until adulthood. An extremely rare case of a previously healthy adult patient with recurrent acute pancreatitis, who was diagnosed with a duodenal duplication cyst is presented. At laparotomy, a duplication cyst measuring 4.8 cm × 4 cm × 4 cm was found adjacent to the ampulla of Vater. A partial cyst excision and marsupialization into the duodenal lumen was performed. The patient is healthy and asymptomatic four years after surgery. The present case illustrates the necessity of considering a duodenal duplication cyst in the differential diagnosis of recurrent acute pancreatitis in previously healthy adults.     

Rare adult gastric duplication cyst mimicking a gastrointestinal stromal tumor

Gastric duplication cyst is a very rare gastrointestinal tract malformation that accounts for 2%-4%of alimentary tract duplications.Most cases are diagnosed within the first year of life,following presentation of abdominal pain,vomiting,and weight loss and clinical discovery of an abdominal palpable mass.This case report describes a very uncommon symptomatic gastric duplication cyst diagnosed for the first time in adulthood.Only a few other case reports of similar condition exist,and all were identified by endosonography.The current case involves a 52-year-old male who presented with a onemonth history of progressive iron deficiency anemia without overt gastrointestinal bleeding.The patient underwent esophagogastroduodenoscopy,which revealed a 2.0 cm pinkish subepithelial lesion,suspected to be a gastrointestinal stromal tumor(GIST)and source of gastrointestinal bleeding.The endosonography showed inhomogeneous hypoechoic lesions with focal anechoic areas arising from a second and third layer of the gastric wall.Differential diagnoses of GIST,neuroendocrine tumor,or pancreatic heterotopia were made.The lesion was removed using an endoscopic submucosal resection technique.Histopathology revealed an erosive gastric mass composed of a complex structure of dilated gastric glands surrounded by fibro-muscular tissue,fibroblasts,and smooth muscle bundles,which led to the diagnosis of gastric duplication.     

Duodenal duplication cyst causing severe pancreatitis： Zmaging findings and pathological correlation

We here report a case of a 18-year-old man with a history of recurrent abdominal pain and a previous episode of severe acute pancreatitis. Abdominal ultrasonography, contrast enhanced multislice computer tomography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography and magnetic resonance imaging demonstrated a cystic mass lesion. Only on delayed phase magnetic resonance images after GadoliniumBOPTA injection, it was possible to demonstrate the lesion's relationship with the biliary tree, differentiating the lesion from intraluminal duodenal diverticulum, and to achieve the diagnosis of duodenal duplication cyst, a recognized rare cause of acute pancreatitis. The diagnosis was confirmed by histology.     

MRI appearance of esophageal duplication cyst

Magnetic resonance imaging (MRI) was utilized to demonstrate an esophageal duplication cyst of the midesophagus in a 61-year-old woman. The radiographic, computed tomographic, and MRI features are illustrated.     

Intramural esophageal bronchogenic cysts: a review of the literature

Bronchogenic cysts are rare congenital cystic lesions mostly located in the middle and superior mediastinum. Esophageal bronchogenic cysts are extremely rare. We review here 23 cases reported in English in the literature to date of intramural esophageal bronchogenic cyst and their features, including our patient. Although they are extremely rare, intramural esophageal bronchogenic cysts should be kept in mind in the differential diagnosis of benign esophageal lesions. With accurate diagnosis and treatment the prognosis is excellent and serious complications may be prevented.     

Adenocarcinoma arising from gastric duplication: a case report with literature review

Gastric duplication is a rare congenital malformation. We report the case of a 50-year-old man with adenocarcinoma derived from gastric duplication. He was referred to our institute because of persistent vomiting due to pyloric stenosis. Abdominal computed tomography revealed two cystic lesions: a 2-cm mass located along the greater curvature of the upper gastric corpus and a 3-cm mass adjacent to the bulbus. Under the diagnosis of gastric duplication cysts, the oral cyst was removed with the gastric wall and the other cyst lesion firmly adhered to the bulbus was treated with distal gastrectomy. Based on histological findings showing adenocarcinoma in the anal duplication cyst wall and regional lymph node metastases and cancer invasion into the duodenal stump, pancreatoduodenectomy was performed 9 days after the initial surgery. Invasion into the pancreas head and duodenal walls was seen in the resected specimen. Although the postoperative course was uneventful, he died of local recurrence and multiple liver metastases 14 months after surgical treatment. This case report with literature review indicates that alimentary tract duplication cysts should be recognized as risky lesions of cancer development in patients aged 50 years or over.     

C ASE R EPORT: Colonic duplication: A rare cause of obstruction

Complete duplication of the entire large bowel with partial ileal involvement is very rare and diagnosis can often be difficult as illustrated by this case report. We also review the other clinical associations of this rare condition and briefly discuss the embryology of duplications of the gastrointestinal tract.     

Successful endoscopic treatment of an esophageal duplication cyst

Duplication cysts of the gastrointestinal tract are rare, particularly in adults. Endoscopic minimally invasive treatment is still a challenging approach even in the endoscopically accessible sections of the gastrointestinal tract. In a 25-year-old patient suffering from dysphagia, an endoscopy and subsequent endosonography revealed a spherical duplication cyst in the lower third of the esophagus, which prompted us to puncture the cyst and subsequently to perform a fenestration (marsupialization; diameter 1 cm) in the anterior wall of the cyst, resulting in permanent drainage of the cystic fluid. Because of the recurrent complaints of the patient after 6 weeks, the anterior wall of the duplication cyst, the former esophageal wall, was partially resected, resulting in a permanent 4-cm opening including the cystic cavity into the esophageal lumen. Thereafter, there were no further complaints from the patient and the findings in the follow-up endoscopy were normal. A successful endoscopic intervention for this type of gastrointestinal duplication cyst is described for the first time. The minimally invasive resection of the anterior wall of the esophageal duplication cyst, simultaneously with the former regular wall at this segment of the esophagus, resulted in permanent inclusion of the cystic cavity into the esophageal lumen with no disadvantageous passage of fluid and food through the lower esophagus or changes in the former cystic epithelium. This method is considered to be feasible and a reasonable treatment alternative to the more invasive surgical approach.     

Gastric duplication: Endoscopic appearance and clinical features

The case of a 13-year-old female presenting with a 6 week history of significant vomiting resulting from a gastric duplication is described. At endoscopy, an antral mass which appeared to change in size and site with peristalsis was evident. Although rare, these lesions need to be considered in the differential diagnosis of patients presenting with symptoms suggestive of gastric outlet obstruction. However, in the majority of cases, the diagnosis is rarely made prior to surgery.     

Laparoscopic resection of esophageal duplication cyst in an adult

We present the case of a 26-year-old woman who underwent a successful laparoscopic resection of an esophageal duplication cyst without any other congenital abnormalities. Although computed tomography (CT) scan and endoscopic ultrasonography (EUS) both assisted in determining the correct preoperative diagnosis, the definitive diagnosis was made following pathological examination of the resected lesion.