Ileo-cecal Sphincteric Duplication-Total Cyst Excision with Ileo-cecal Valve Preservation

Case Report

Austin J Clin Case Rep. 2014;1(8): 1040.

Ileo-cecal Sphincteric Duplication-Total Cyst Excision with Ileo-cecal Valve Preservation

Govani DR1, Patel RR2, Patel RV3* and Doshi S4

1University of Birmingham Medical School, UK

2Department of Pediatrics, Saurashtra University, India

3Department of Ped Surgery, Saurashtra University, India

4Department of Pediatrics, Saurashtra University, India

*Corresponding author: Patel RV, Department of Surgery, Postgraduate Institute of Child Health and Research and K T Children Government Hospital, Saurashtra University, Rajkot 360001 Gujarat, India

Received: July 25, 2014; Accepted: August 24, 2014; Published: August 26, 2014

Abstract

We report a case of prenatally diagnosed and postnatally confirmed ileal duplication cyst situated close to ileo-cecal valve. The size of the cyst was smaller than 5 cm diameter and an elective admission with laparoscopic excision was planned at 3 months of age to avoid any anesthetic or hospitalization related complications. However, the infant presented in emergency with massive lower gastrointestinal bleeding requiring transfusion. At exploration, a terminal ileal duplication cyst in the ileocecal sphincteric area was found which was excised without resection of bowel or the ileocecal valve. Histopathological examination confirmed ectopic gastric mucosa with ulceration in the transitional area. The case is very interesting and the debate about the conservation or the resection of the ileocecal valve in ileocecal cyst duplication has been presented with review of relevant literature.

Keywords: Infant; Ileal; Duplication; Cyst; Ectopic gastric mucosa; Gastrointestinal bleeding; Ileo-cecal valve; Preservation

Introduction

Ileocecal valve appears to be a key vital structure in children in general and neonates and infants in particular. It plays a fundamental role in the growth and development of the body, regulates intestinal transit and acts as barrier to delay passage of intraluminal small bowel material increasing their absorption [1]. It is a strong anti-reflux mechanism to prevent reflux from the cecum into the terminal ileum acting as an important barrier water shade and keeping small bowel contents free from gross contamination and bacterial overgrowth [2]. We wish to report a unique case of an infant with ileo-sphinteric duplication cyst very close to the ileocecal valve in whom we could excise the whole cyst with preservation of ileocecal valve and avoided resection and anastomosis.

Case Presentation

A term baby girl weighing 3540 gm was born by vaginal delivery. Prenatal scans detected an abdominal cyst which was confirmed on postnatal scan measuring 24.2 X 25.6 mm and having double lines suggestive of a cystic duplication cyst (Figure 1). She was sent home at birth and an elective laparoscopic excision was planned at 3 months of age.

Citation: Govani DR, Patel RR, Patel RV and Doshi S. Ileo-cecal Sphincteric Duplication-Total Cyst Excision with Ileo-cecal Valve Preservation. Austin J Clin Case Rep. 2014;1(8): 1040. ISSN 2381-912X