Diagnosis of Gastric Duplication Cysts in a Child by Endoscopic Ultrasonography
Gastric duplication cysts (GDCs) are rare congenital malformations that account for approximately 2% to 9% of all alimentary tract duplications. The estimated incidence of GDCs in children is around 17 cases per million. These cysts can present with a variety of symptoms, including abdominal pain, abdominal distension, nausea, vomiting, dysphagia, dyspepsia, and weight loss. Despite their rarity, GDCs are clinically significant due to their potential to cause complications and the challenges associated with their diagnosis. This case report highlights the successful diagnosis of a GDC in a 7-year-old girl using endoscopic ultrasonography (EUS), emphasizing the utility of this imaging modality in pediatric patients.
Case Presentation
A 7-year-old girl was admitted to The First Hospital of Jilin University on August 28, 2016, due to persistent vomiting lasting three days. Initial ultrasonography revealed a cystic echogenic mass measuring approximately 61.4 mm × 38.4 mm × 46.6 mm located between the gastric antrum and the duodenum. The mass had a clear boundary, and its wall structure resembled that of the digestive tract. Abdominal computed tomography (CT) further identified a cystic low-density mass in the hilar region, although the boundary between the antrum and duodenum was unclear.
Diagnostic Procedures
To further investigate the lesion, gastroscopy was performed on August 31, 2016, under general anesthesia. The child was placed in the left lateral position, and the gastroscope was advanced through the mouth and esophagus into the stomach. Gastroscopy revealed a 4 cm × 3 cm bulge in the posterior wall of the antrum. The surface of the bulge was smooth, and its color was similar to that of the surrounding mucosa.
Endoscopic ultrasonography (EUS) was subsequently conducted using an ultrasonic probe with a frequency of 20 MHz. The probe was passed into the stomach through the biopsy tube, and water was injected to facilitate ultrasonic scanning. EUS demonstrated a normal 5-layer structure of the stomach wall and identified a cystic structure measuring 4 cm × 3 cm outside the wall. The cystic structure had no internal echo, and its interior consisted of a medium echo structure. The lesion was closely adherent to the stomach wall and bulged into the cavity. Based on these findings, a diagnosis of gastric duplication cyst was considered.
Surgical Intervention and Pathological Findings
Following the initial diagnosis, the child was transferred to the department of surgery for further management. On September 6, 2016, laparoscopic exploration was performed under general anesthesia with endotracheal intubation. Intraoperatively, a cystic mass measuring approximately 4 cm × 3 cm × 2 cm was observed in the stomach wall. The mass was heavily adherent to the gastric mucosa. The cyst was completely excised, and pathological examination revealed smooth muscle tissue in the mucosa and ectopic pancreatic tissue in the wall, confirming the diagnosis of gastric duplication cyst.
Discussion
Gastrointestinal tract duplications are rare congenital anomalies, with gastric duplications being particularly uncommon. The diagnosis of GDCs is challenging due to their nonspecific symptoms and the limitations of conventional imaging techniques. Abdominal ultrasound, CT, and magnetic resonance imaging (MRI) are commonly used to evaluate suspected GDCs, but these modalities have significant limitations. For instance, the reported rate of misdiagnosis with CT scanning ranges from 43% to 70%, and MRI may not significantly improve diagnostic accuracy.
Endoscopic ultrasonography (EUS) has emerged as a valuable tool for the diagnosis of GDCs. EUS combines endoscopy and ultrasound to provide detailed images of the digestive tract wall and adjacent structures. This technique offers several advantages, including the ability to distinguish between solid and cystic masses and to provide preliminary information about the nature and origin of lesions. EUS is particularly useful for evaluating submucosal lesions and is considered the preferred imaging modality for preoperative diagnosis of GDCs.
While EUS is more commonly used in adults, there have been few reports of its application in pediatric patients. In this case, EUS played a critical role in accurately diagnosing a GDC in a 7-year-old girl. The procedure helped determine the depth and size of the lesion, avoided misdiagnosis, and guided surgical management. This case underscores the utility of EUS in the preoperative assessment of GDCs in children.
Conclusion
Gastric duplication cysts are rare congenital malformations that can present with a variety of nonspecific symptoms. The diagnosis of GDCs is challenging, and conventional imaging techniques often fall short. Endoscopic ultrasonography (EUS) has proven to be a valuable diagnostic tool, offering detailed visualization of the digestive tract wall and adjacent structures. This case report highlights the successful use of EUS in diagnosing a GDC in a pediatric patient, demonstrating its efficacy and reliability in this population. EUS should be considered a preferred imaging modality for the preoperative evaluation of suspected GDCs in children.
doi.org/10.1097/CM9.0000000000000077
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