Appendicitis and incidental foregut duplication cyst

Discussion:

A young male presented to the ED with clinical signs of acute appendicitis. Complete blood count: mild leukocytosis.

Signs of appendicitis and incidental benign appearing lesion at US and CT. Resection of the lesion at appendectomy was recommended as a preventive measure, so that the lesion would not serve as a lead point for intussusception or cause ileal volvulus.

At surgery, an inflamed appendix was resected. The oval lesion was located 40 cm proximal to the ileocecal valve. The lesion was removed, along with 8 cm of ileum.

Pathology report for appendix: "Acute appendicitis."

Pathology report for lesion:
"Sections show cystic subserosal nodule containing organic material of unclear origin surrounded by histiocytes, fibrous capsule and duplicated muscular wall. May be compatible with cystic intestinal duplication."

NB: Given that the lesion proved to be an intestinal duplication cyst, the intralesional high density could very well have been contrast material. This implies a connection between the ileal lumen and the intralesional space, which is rare in foregut duplication cysts.

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