Journal of Visceral Surgery (2014) 151, 479—480

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Retroperitoneal gastric duplication cyst B. Malgras a,∗, J.-B. Souraud b, O. Chapuis a a

Service de chirurgie digestive, HIA Val de Grâce, Paris, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France b Service d’anatomopathologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France Available online 29 August 2014

KEYWORDS Cyst; Duplication; Gastric; Retroperitoneal; Surgery

Retroperitoneal gastric duplication is an extremely rare congenital malformation. It is usually diagnosed pre-natally or during infancy. In the adult patient, it is included in the differential diagnosis of retroperitoneal cystic masses and usually presents with symptoms. The diagnosis of intestinal duplication is based on the Rowling criteria: the wall of the cyst must be in contact with the duplicated organ with an external layer of smooth muscle and an internal surface of intestinal mucosa [1]. Gastric duplications are usually cystic without any internal communication with the intestinal lumen (70% of cases), but they can occasionally be tubular in shape and/or communicating. Classical imaging modalities (CT/MRI) do not contribute much to diagnosis, having only a weak and variable sensitivity (40—70%) [1] (Fig. 1). Endoscopic ultrasound with or without needle aspiration is the most sensitive study, demonstrating the cyst to have a double wall (a hypo-echogenic outer layer corresponding to the smooth muscle and a hyper-echogenic

Figure 1. spleen.



Retroperitoneal cystic lesion seen on abdominal CT scan: 1: cystic lesion; 2: stomach; 3:

Corresponding author. E-mail address: [email protected] (B. Malgras).

http://dx.doi.org/10.1016/j.jviscsurg.2014.06.001 1878-7886/© 2014 Elsevier Masson SAS. All rights reserved.

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Figure 3. Microscopic appearance of the cystic lesion (100× magnification): 1: gastric fundus type mucosa (parietal and chief cells); 2: amorphic pale eosinophilic material within the lumen of the cyst.

at the time of surgical resection or postoperatively based on pathology findings (Figs. 2 and 3). Surgical resection is the appropriate treatment for gastric duplications because of their risk of complications (ulceration, hemorrhage, perforation, compressive symptoms) and the long-term risk of malignant degeneration. Surgical resection should be conservative, limited only to the cystic lesion. This can sometimes be performed laparoscopically, which results in lower morbidity [3].

Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.

References

Figure 2. a: intra-operative view of the duplication cyst: 1: cystic lesion; 2: stomach; b: gross appearance after complete resection: 1: cystic lesion.

inner layer corresponding to the digestive mucosa). Analysis of needle aspirate aids the diagnosis particularly if levels of amylase and tumor markers (CEA/CA19.9) are low [2]. Frequently, the diagnosis is only considered intra-operatively

[1] Etienne S, Pilette C, Prophette B, Serra-Maudet V. Gastric duplication in the adult: a case report presenting as recurring acute edematous pancreatitis. Ann Chir 2002;127:641—4. [2] Singh JP, Rajdeo H, Bhuta K, Savino JA. Gastric duplication cyst: two case reports and review of the literature. Case Rep Surg 2013 [Epub 2013 Feb 19]. [3] Upadhyay N, Gomez D, Button MF, Verbeke CS, Menon KV. Retroperitoneal enteric duplication cyst presenting as a pancreatic cystic lesion. A case report. JOP 2006;7:492—5.

Retroperitoneal gastric duplication cyst.

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