See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/228329265 A rare presentation of colonic duplication cyst: Report of a case and review of literature Article in JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR) · March 2012 DOI: 10.5334/jbr-btr.92 · Source: PubMed CITATIONS READS 5 920 4 authors , including: Konstantinos Stefanidis Chrysafoula Kolofousi King's College Hospital NHS Foundation Trust Evangelismos Hospital 31 PUBLICATIONS 496 CITATIONS 5 PUBLICATIONS 38 CITATIONS SEE PROFILE SEE PROFILE All content following this page was uploaded by Konstantinos Stefanidis on 26 July 2014. The user has requested enhancement of the downloaded file.
JBR–BTR, 2012, 95: 71-73. A RARE PRESENTATION OF COLONIC DUPLICATION CYST: REPORT OF A CASE AND REVIEW OF LITERATURE K. Stefanidis, I. Lappas, Ch. Kolofousi, I. Kalogeropoulos 1 Duplication cyst is an uncommon congenital abnormality of the alimentary tract. It can occur anywhere in the alimentary tract with the ileum and the jejunum representing the most common sites of duplication. Most often the patients are asymptomatic and colonic duplication cysts remain undiagnosed for years. In this case report we present an unusual case of colonic duplication cyst with a transverse colon location. We present the radiological findings of this rare congenital malformation in order to be included in the differential diagnosis of cystic masses of the gastrointestinal tract. Key-word: Colon, abnormalities. Duplication cyst is an extremely rare congenital malformation of the alimentary tract. It occurs most often in the ileum, accounting for over 60% of cases followed by the jejunum and the duodenum (1). The colon is the least common site of enteric duplication. In fact, in a review of 495 alimentary tract dupli- cations only 7% of the duplications involved the colon (2). To our knowl- edge less than 100 cases have been described in the published litera- ture (3). Case report We present an unusual case of colonic duplication cyst in a 45-year- old Caucasian man who presented to our hospital with lumbar pain. The patient had a medical history of con- stipation. On admission, the patient was afebrile. Physical examination revealed a large mass in the left upper quadrant with mild diffuse tenderness and no peritoneal signs. Blood laboratory tests were within normal limits. An initial plain X-ray was performed with no abnormal findings. Ultrasonography was insignificant due to gas filled bow- els. After the first inconclusive radio- Fig. 1. — Abdominal X-ray following the contrast barium logical exams, a contrast Barium enema study in upright position. It shows a large structure Enema study was decided to be per- (white arrows) with contrast due to communication with the formed. Barium Enema showed a transverse colon with air-fluid level (black arrows). large air-filled tubular structure in the left upper quadrant containing an air-fluid level (Fig. 1). The same cystic structure was partially filled (Fig. 2). At the same examination the oral contrast material was per- with contrast due to communication gastric antrum was recognized as a formed. It demonstrated a large air- with the transverse colon at the smaller air-filled structure adjacent filled 14 × 7 cm structure containing splenic flexure. The shape of the cys- to the same tubular structure. oral contrast in the left upper quad- tic structure changed with peristalsis Furthermore, Computed Tomo - rant (Fig. 3). CT confirmed the find- and the position of the patient graphy (CT) of the abdomen with ings of contrast Barium Enema study and a possible diagnosis of colonic duplication of the transverse com- mon was concluded. A surgical inter- vention was decided in order to pre- From: 1. Radiological Department, Evangelismos Hospital, Athens, Greece. vent complications of the colonic Address for correspondence: Dr K. Stefanidis, M.D., Radiological Department, duplication cyst. At operation, the Evangelismos Hospital, Ipsilantou 45-47 , 10676, Athens, Greece. cyst was excised with a segment of E-mail: kostef77@gmail.com
72 JBR–BTR, 2012, 95 (2) Fig. 3. — Computed Tomography of the abdomen demonstrat- ing the cystic structure (arrows) containing an air-fluid level. Fig. 2. — Abdominal X-ray following the contrast Barium Enema study in supine position demonstrates the change of the shape of the cystic air-filled structure (arrowheads). transverse colon and a colocolosto- my was performed (Fig. 4). The dupli- cation cyst was attached to the trans- verse colon with the presence of a small communication with the Fig. 4. — Surgical specimen including part of the transverse colonic lumen. Post-operative recov- colon with the duplication. ery was uneventful. Discussion infection or constipation (3, 6-9). In radiography may be normal or may Enteric duplications cysts are one race case of combined duplica- show a soft tissue mass with/without uncommon congenital malforma- tion of the colon and vermiform displacement of adjacent bowel or tions (4). They are usually discovered appendix, it was presented with evidence of intestinal obstruction. in infancy and childhood, but they hydronephrotic atrophy of the kid- Ultrasound is particularly well suited may be discovered at any period of ney (10). Also patients can present a for the identification and characteri- life. They occur anywhere along the variety of non-specific signs and zation of duplication cysts, although length of the alimentary tract on the symptoms like abdominal pain. in our case it was inconclusive (15- mesenteric side. The location at the Resection of the duplication cyst and 16). Contrast examinations of the transverse colon is extremely the adjacent bowel is recommended gastrointestinal tract can be useful in rare (2). Their walls may contain all because of the possibility of malig- order to demonstrate displaced of the normal bowel layers, includ- nant changes and the risk of gas- loops of bowel surrounding the pre- ing the mucosa, submucosa and trointestinal ulceration and haemor- sumed cyst and depict the communi- muscularis. They may appear as cys- rhage due to ectopic gastric cation with the gastrointestinal tic or tubular malformations. While mucosa (11). To avoid any future tract (17). In our case the use of con- duplication cysts typically do not complications, cyst resection is indi- trast in the Barium Enema study communicate with the adjacent cated even in the asymptomatic revealed the origin of the cystic bowel lumen, tubular lesions, which patient (12-14). structure and depicted the commu- usually arise near the colon, may The diagnosis of a duplication nication with the transverse colon. In communicate. cyst is difficult to be made clinically. difficult cases which require a multi- Most colonic duplication cysts are Radiological studies play an impor- planar approach to delineate the asymptomatic and remain undiag- tant role in the detection and diagno- relationship between the cystic and nosed for years (5). If symptomatic, sis of the duplication cysts. Plain film peripheral structures, CT and MRI they manifest obstruction, bleeding,
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