Cecal Duplication Associated with an Ovarian Dermoid Cyst: Report
of a C a s e *
I. BELLENIS, M.D., F.R.C.S., t A. E. STUART,M.B., F.R.C.S. + From the Department of Surgery, OIdchurch Hospital, Romlord, Essex, England
CECAL DUPLICATION is a r a r e form of intestinal duplication. A case in which the duplication produced an abnormal gas shadow on plain abdominal x-ray and was associated with a dermoid cyst of the ovary is reported.
Report of a Case A 13-year-old girl was a d m i t t e d to the hospital with pain in the right iliac fossa, distention a n d vomiting. Previous similar attacks were recorded, a n d the p a t i e n t also h a d a long history of constipation. E x a m i n a t i o n revealed m a r k e d tenderness of the right lilac fossa b u t no fever. Plain a b d o m i n a l films showed an a b n o r m a l gas shadow parallel to the cecal shadow (Fig. 1). At l a p a r o t o m y a t u b u l a r cecal diverticulum, 20 cm long and filled with inspissated feces, was found; distally this was attached to an ovarian d e r m o i d cyst containing h a i r (Fig. 2). T h e a p p e n d i x was normal. Unusually, a n d fortuitously, the diverticul u m was attached to the antimesenteric border a n d so resection was uncomplicated.
Discussion
Intestinal duplication can occur anywhere from the mouth to the anus, although small intestinal duplications are commonest. 1 T h e y may be spherical or tubular, com* Received for publication J u n e 14, 1976. "~Surgical registrar. + Senior surgical registrar: Address reprint requests to Dr. Stuart: Senior Surgical Registrar, D e p a r t m e n t of Surgery, O l d c h u r c h Hospital, R o m f o r d , Essex R M 7 0 B E , England.
FIG. 1. Plain supine a b d o m i n a l x-ray, showing double cecal shadow.
municating or noncommunicating, and can be classified as 1) mesenteric cysts, 2)diverticula, or 3) long intestinal duplications. 4 Unlike most intestinal diverticula, these duplications contain all coats of the bowel wall. T h e mucosa is usually similar to that
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Fro. 2. Large cecal duplication with attached dermoid cyst.
of the a d j a c e n t bowel, b u t can be d i s s i m i l a r w h e n the presence of gastric or p a n c r e a t i c e p i t h e l i u m m a y l e a d to u l c e r a t i o n a n d b l e e d i n g 3 W h e n b o t h ends of the d u p l i c a t i o n c o m m u n i c a t e w i t h the l u m e n of the bowel, the p a t i e n t m a y have no s y m p t o m s . W h e n o n l y o n e e n d c o m m u n i c a t e s , the b l i n d sac f r e q u e n t l y causes p r o b l e m s by b e i n g i n t e r m i t t e n t l y filled w i t h secretions o r fecal m a t e r i a l . Colonic d u p l i c a t i o n s can be associated w i t h a n o m a l i e s of the u r i n a r y tract, a n d
m a l i g n a n c y is r e p o r t e d to occur occasionally. a T h i s is the first d e s c r i p t i o n of a cecal d u p l i c a t i o n i n association w i t h a d e r m o i d cyst. References 1. Bishop HC, Koop CE: Surgical management of duplications of the alimentary tract. Am J Surg 107: 434, 1964 2. Burne JC: Pancreatic and gastric heterotopia in a diverticulum of the transverse colon. J Pathol 75: 470, 1958 3. Larizadeh R, Powell DE: Neoplastic change in a duplicated colon. Br J Surg 52: 666, 1965 4. McPherson AG, Trapnell JE, Airth GR: Duplication of the colon. Br J Surg 56: 138, 1969
of a C a s e *
I. BELLENIS, M.D., F.R.C.S., t A. E. STUART,M.B., F.R.C.S. + From the Department of Surgery, OIdchurch Hospital, Romlord, Essex, England
CECAL DUPLICATION is a r a r e form of intestinal duplication. A case in which the duplication produced an abnormal gas shadow on plain abdominal x-ray and was associated with a dermoid cyst of the ovary is reported.
Report of a Case A 13-year-old girl was a d m i t t e d to the hospital with pain in the right iliac fossa, distention a n d vomiting. Previous similar attacks were recorded, a n d the p a t i e n t also h a d a long history of constipation. E x a m i n a t i o n revealed m a r k e d tenderness of the right lilac fossa b u t no fever. Plain a b d o m i n a l films showed an a b n o r m a l gas shadow parallel to the cecal shadow (Fig. 1). At l a p a r o t o m y a t u b u l a r cecal diverticulum, 20 cm long and filled with inspissated feces, was found; distally this was attached to an ovarian d e r m o i d cyst containing h a i r (Fig. 2). T h e a p p e n d i x was normal. Unusually, a n d fortuitously, the diverticul u m was attached to the antimesenteric border a n d so resection was uncomplicated.
Discussion
Intestinal duplication can occur anywhere from the mouth to the anus, although small intestinal duplications are commonest. 1 T h e y may be spherical or tubular, com* Received for publication J u n e 14, 1976. "~Surgical registrar. + Senior surgical registrar: Address reprint requests to Dr. Stuart: Senior Surgical Registrar, D e p a r t m e n t of Surgery, O l d c h u r c h Hospital, R o m f o r d , Essex R M 7 0 B E , England.
FIG. 1. Plain supine a b d o m i n a l x-ray, showing double cecal shadow.
municating or noncommunicating, and can be classified as 1) mesenteric cysts, 2)diverticula, or 3) long intestinal duplications. 4 Unlike most intestinal diverticula, these duplications contain all coats of the bowel wall. T h e mucosa is usually similar to that
255 Dis. CoL & Rect. April, 1977
Volume 20 Number 3
256
B E L L E N I S AND S T U A R T
Dis. Col. & Rect. April, i977
Fro. 2. Large cecal duplication with attached dermoid cyst.
of the a d j a c e n t bowel, b u t can be d i s s i m i l a r w h e n the presence of gastric or p a n c r e a t i c e p i t h e l i u m m a y l e a d to u l c e r a t i o n a n d b l e e d i n g 3 W h e n b o t h ends of the d u p l i c a t i o n c o m m u n i c a t e w i t h the l u m e n of the bowel, the p a t i e n t m a y have no s y m p t o m s . W h e n o n l y o n e e n d c o m m u n i c a t e s , the b l i n d sac f r e q u e n t l y causes p r o b l e m s by b e i n g i n t e r m i t t e n t l y filled w i t h secretions o r fecal m a t e r i a l . Colonic d u p l i c a t i o n s can be associated w i t h a n o m a l i e s of the u r i n a r y tract, a n d
m a l i g n a n c y is r e p o r t e d to occur occasionally. a T h i s is the first d e s c r i p t i o n of a cecal d u p l i c a t i o n i n association w i t h a d e r m o i d cyst. References 1. Bishop HC, Koop CE: Surgical management of duplications of the alimentary tract. Am J Surg 107: 434, 1964 2. Burne JC: Pancreatic and gastric heterotopia in a diverticulum of the transverse colon. J Pathol 75: 470, 1958 3. Larizadeh R, Powell DE: Neoplastic change in a duplicated colon. Br J Surg 52: 666, 1965 4. McPherson AG, Trapnell JE, Airth GR: Duplication of the colon. Br J Surg 56: 138, 1969
