A gastric duplication cyst is a rare congenital foregut duplication cyst affecting the stomach. It accounts for less than 10% of all gastrointestinal duplications. The most common site of gastrointestinal tract duplication cysts (GTDCs) is the ileum, followed by oesophagus, large bowel and jejunum.
A review of four large series comprising 281 cases of GTDC1, demonstrated that duplications of the stomach constituted about 7%.
Clinical manifestations are dependent on location, size, and mucosal pattern. Symptoms usually appear before one year of age as an upper abdominal obstruction, abdominal pain or a palpable mass 2.
By definition, the gastric duplication have some defining characteristics as a well developed layer of smooth muscle, an epithelial lining represents some part of the alimentary tract, and are attached to some part of the stomach sharing a common muscle wall and blood supply 3
Duplication cysts may also contain heterotopic tissue which can include
- gastric mucosa
- pancreas: ectopic pancreatic tissue
- lymphoid tissue
- respiratory epithelium
The majority are non-communicating, spherical cysts and the greater curve is the most common site of its occurrence 1.
Abdominal plain radiography can demonstrate a soft tissue mass displacing air-filled bowel loops. There can be occasional calcification in the cysts wall 6.
Sonography plays an important role in these patients and many authors have demonstrated that the combination of an echogenic inner mucosal layer and hypoechoic outer muscular layer are highly suggestive of a GTDC 4.
A barium study may show a filling defect due to extrinsic compression from these cystic masses.
CT scans will show a fluid-attenuation cystic mass in close contact with the stomach.
Magnetic resonance demonstrates features common to cysts with typical signal characteristics being
- T1: low signal
- T2: high signal
- T1 C+ (Gd): the cyst wall can show slight enhancement 6
Recognised complications include:
The above complications are especially likely if duplications cysts contain ectopic gastric mucosa (which occurs in 20-50% of duplications) or ectopic pancreatic tissue 6.
General imaging differential considerations include
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