Gastric Duplication

The gastric duplication cyst represents only 4% of all enterogenous duplications and thus is the least common of all GI duplications (Pruksapong et al. 1979). It can be seen as an isolated finding or in association with other anomalies such as an aberrant pancreas, vertebral anomalies (Schlesinger and Parker 2003) or a pulmonary sequestration (Chen et al. 2006; Granata et al. 2003). Duplication anomalies are usually adjacent to involved bowel and will mainly be located along the greater curvature of the stomach, often in the antrum. They will be spherical or occasionally tubular in configuration and may communicate with the lumen. The duplication is composed of a smooth muscle wall continuous with the muscle layer of the intestinal wall and an inner mucosal lining.

Presenting symptoms may include vomiting (obstruction), hematemesis, melena or palpable mass.

Plain abdominal X-ray may demonstrate a soft tissue mass in between the greater curvature of the stomach and superior to the transverse colon (Barlev and Weinberg 2004). This is seldom seen.

On barium studies, a large gastric duplication may be recognized as an intramural, extraluminal soft tissue mass which causes displacement of the gastric lumen. However the diagnosis will often be made by US where the typical bowel wall can be recognized: an inner thin echogenic line, consistent with the mucosa, and an outer hypoechoic layer, consistent with the muscular layer (Fig. 3.3). Furthermore, the gastric duplication is located intramurally and is filled with anechoic fluid. Less commonly it is filled with echogenic material, representing hemorrhage, infection or proteinaceous fluid.

Fig. 3.3. US of duplication cyst of the greater curvature of the stomach: classic double echo pattern of the GI mucosa. (Courtesy of Dr. Carlo Buonomo, Boston, MA, USA)

The imaging diagnosis can also be made by CT or MR, on which the gastric duplication cyst is filled with low attenuation fluid/low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, or less commonly with high attenuation fluid/high signal intensity on T1-weighted images.

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Responses

  • Dehab
    Do you have to remove a gastric duplication cyst?
    3 months ago

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