Paediatric Duplication cyst treat with Laparoscopic procedure
GI tract duplication cysts are congenital gastrointestinal malformations. It means that duplication cysts are abnormally formed in the baby during 5-8 weeks of pregnancy. Generally, duplication cysts are rare but usually present within the first two years of life. They can be anywhere along the gastrointestinal tract. Hence, they categorize into various duplication cyst types based on their location. Duplication Cysts can be more common in males than females. The exact cause of the formation of these duplications is still unknown.
Usually, these malformations are located during a routine test or diagnosis for some other ailment. So, it is because pediatric duplication cysts may show some symptoms or be silent, showing no observable signs of anomaly. Mostly, these are asymptomatic but can be diagnosed at an early age when accompanied by some clinical symptoms.
Symptoms of paediatric duplication cyst
According to various case studies published so far, some of the common symptoms may include the following.
- Local pressure symptoms such as nausea, vomiting
- Bowel inflammatory obstruction
- Pancreatitis
- Abdominal pain
- Palpable mass (a hard mass that can be felt when touched)
- Recurrent feed intolerance
- Bleeding
- · Bile duct obstruction
- · Achalasia
- · Symptoms of Hirschsprung’s disease
Due to undefined clinical characteristics or duplication cyst symptoms for all the duplication cyst types, it is challenging to define the diagnostic approach. But, in some cases, exploratory laparoscopy confirms the diagnosis. At the same time, endoscopic ultrasound (EUS) has been beneficial in evaluating and diagnosing the cyst. Additionally, EUS-fine needle aspiration (EUS-FNA) also offers a definitive diagnosis.
Furthermore, there are mainly two schools of thought on paediatric duplication cyst treatment. First, some medical experts believe that when diagnosed, duplication cysts surgery with laparoscopic procedure is a must to remove the cyst. But, some believe surgery is not the best treatment if asymptomatic, but the physician should be wary of any possible complications.
So, can a duplication cyst be cancerous?
For a short answer, it is scarce for a duplication cyst to transform into a cancerous mass. According to a scientific study, very few cases of duplication cyst carcinoma have been registered in the literature so far. Cancerous transformation of different duplication cyst types includes squamous cell carcinoma, carcinoid tumour, and adenocarcinoma. Mainly, cancerous duplication cysts are most likely to form in the small bowel, rectum, colon etc. Furthermore, carcinoma formation in the small intestine is most likely to occur in the ileum. Carcinoma in duplication cysts located in the jejunum is very rare.
The best duplication cyst treatment in Pakistan for cancerous cyst is ought to be surgical removal. But, the delayed diagnosis can lead to advanced stages of the tumour, which may result in worse symptoms and increased operative and post-operative risks. Hence, it is vital to visit Dr Mohsin at ALSA for the best paediatric duplication cyst treatment as soon as you observe anything related to the symptoms mentioned in the above section.
Duplication cyst types
As described earlier, duplication cysts are categorized on the basis of their location along the gastrointestinal tract. Hence, here is an overview of all the duplication cysts reported so far.
1. Oesophagal duplication cyst
About 10-15% of the duplication cysts are oesophagal cysts, the second most prevalent. Mainly, these cysts cause noticeable symptoms and are diagnosed in childhood. Duplication cyst symptoms also depend upon the location of the cyst. For example, an oesophagal duplication cyst in the upper oesophagus may cause a nonproductive cough or stridor (whistling sound as the patient breathes). Cysts of the middle and lower oesophagus may cause epigastric discomfort, dysphagia, vomiting, and chest pain. But, in some cases, there may be pain behind the breast bone or between the shoulder blades, cyst ulceration/rupture, and bleeding.
For the treatment, surgical removal or enucleation of the cysts is the most preferred approach, especially in symptomatic patients, whereas, in asymptomatic patients, some doctors believe that the patient must be observed for any changes or symptoms.
2. Gastric duplication cyst
Approximately 4% to 9% of all the duplication cyst types are gastric duplications. The cause or origin of gastric duplication is yet unknown. They may cause no symptoms at all, or the patient may suffer from different symptoms such as diffuse abdominal pain, weight loss, epigastric pain, ulcerated antral mass, and gastric outlet obstruction.
There is some chance that the gastric duplication cysts may transform into a cancerous mass. Hence, the doctors suggest surgical removal of even the asymptomatic gastric duplication cyst.
3. Bronchiogenic duplication cyst
These are the abnormalities of the lung, and the lower lobe mainly contains the cyst. It may be a few centimetres big in a round or oval shape and contain fluid, air or secretion. Most of the patients are asymptomatic. However, the patients may exhibit abdominal pain, shortness of breath, cough, chest pain, dysphagia (swallowing disorder) etc.
As for the other duplication cyst types, the treatment approach for the symptomatic cases is the surgical removal of the cysts. However, in asymptomatic cases, the surgical removal of the cyst and surrounding tissue is the best to rule out the chances of complications such as the formation of the carcinoma.
4. Small bowel duplication cysts
Small bowel duplication cysts can be of three subtypes such as duodenal, jejunal, and ileal. Among all the three types of jejunal duplications, they are the most common of all and account for 50%, ileal duplications 44%, and duodenal 2-12% of all GI tract duplications.
Symptoms of the small bowel duplication cysts include vomiting and abdominal pain. Duodenal cysts may also cause infection, weight loss, Pancreatitis, and GI bleeding. Jejunal duplication cysts may cause abdominal bloating, constipation, and small bowel obstruction, and ileal duplications can be asymptomatic or may exhibit pain and obstruction. Treatment of the symptomatic small bowel cysts is the surgical removal of the cyst from the tissue.
5. Large bowel/ rectal duplication cyst
Colonic duplications accounting for about 6.8% of all the duplication cyst types in the GI tract, can be anywhere in the large intestine. These cysts can be asymptomatic or cause extreme abdominal pain, blockage, and bleeding. Importantly, 67% of the reported duplication cysts malignancies are large intestine duplication cysts.
Either asymptomatic or symptomatic, the treatment approach for large bowel cysts is the surgical removal of the cyst. Hence, the doctors rule out the risks of perforation, bleeding, blockage, and transformation into a cancerous mass.
Conclusion
Irrespective of the duplication cyst types, paediatric duplication cysts rarely transform into cancer. However, there is some chance of malignancy. Duplication cysts may or may not be symptomatic, and the most recommended duplication cyst treatment approach Is duplication cysts surgery with laparoscopic procedure. Hence, get the best duplication cyst treatment in Pakistan from the best paediatric surgeon and avoid all the possible complications discussed above.