Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(1) > 1043483

Korean J Pediatr Gastroenterol Nutr. 2010 Mar;13(1):75-80. Korean.
Published online March 31, 2010.  https://doi.org/10.5223/kjpgn.2010.13.1.75
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
A Case of Intestinal Duplication Cyst Identified as Pathological Lead Point in a Child with Recurrent Intussusception
Kun Song Lee, M.D., Ji Yun Park, M.D., Jong Seok Oh, M.D., In Chang Seong, M.D., Kang Min Han, M.D.,* and Young Seok Lee, M.D.
Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea.
*Department of Pathology, College of Medicine, Dankook University, Cheonan, Korea.
Department of Radiology, College of Medicine, Dankook University, Cheonan, Korea.

Responsible author (Email: pdlks@hanmail.net )
Received January 31, 2010; Accepted March 08, 2010.

Abstract

Intestinal duplication cysts are characterized by the attachment to some part of the gastrointestinal tract with which a blood supply is shared, and have an epithelial lining resembling some part of the alimentary tract. A 15-month-old female was admitted to our hospital with cyclic irritability, vomiting, and blood-tinged stool. The results of an ultrasound showed an ileocolic intussusception and a 1.3 cm cystic mass had double-wall sign and a Y-configuration with an adjacent ileal loop. She had a past history of two ileocolic intussusceptions. The cystic mass was considered to be a pathologic lead point, so resection and end-to-end anastomosis was performed. The gross and histologic evaluation of the specimen demonstrated a 2.4×2.4 cm cystic mass containing yellow mucoid fluid and the cyst wall was lined with intestinal and gastric mucosa and enclosed by a layer of muscle, which was shared with the adjacent ileum.

Keywords: Intestinal duplication cyst; Intussusception; Pathologic lead point; Double wall sign; Y-configuration

Figures


Fig. 1
(A) Ultrasound shows a cystic mass with a double-layered wall consisting of an echogenic inner layer (black arrow) and a hypoechoic outer layer (white arrow). (B) A Y-configuration is shown at the junction of the cyst and adjacent small bowel (oval line).
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Fig. 2
On a contrast-enhanced CT scan, a 2.4 cm cystic-like mass with an enhancing wall (arrow) is demonstrated in the left lower peritoneal cavity adjacent to an ileal loop.
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Fig. 3
The gross specimen demonstrates a 2.4×2.4 cm cystic mass adjacent to an ileal loop.
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Fig. 4
(A) Low-power histologic photomicrograph demonstrates the cyst with a layer of muscle (arrowhead) is shared with adjacent ileum, and the white box represents a low magnification lesion of (B) (H&E, ×12.5). (B) The cystic outer wall is lined with shared normal intestinal mucosa (yellow arrow) and the inner wall is lined with ectopic gastric mucosa (black arrow; H&E, ×40).
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Fig. 5
The cystic wall consists of inner hyperechoic and outer hypoechoic layers, known as the double-wall sign, and two Y-configurations (white line) are visible at the junctions of the cyst and adjacent small bowel loop (ref. 14).
Click for larger image

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