Ijaz et al, Cecal Duplication Cyst
I MAGES
Cecal Duplication Cyst Presenting as Acute Intestinal Obstruction in an Infant
Lubna Ijaz, Muhammad Husnain, Shahid Iqbal Malik, Bilal Mirza*
A 45-day-old male infant presented with signs of acute
intestinal obstruction for two days. Abdominal
examination revealed a mass in the right lower abdomen.
Ultrasound showed a cystic mass measuring 4x3 cm, in
the right lower quadrant at the level of lower pole of right
kidney. The plain abdominal radiograph showed haziness
in the middle and lower third with bowel loops pushed to
upper third of the abdomen (Fig. 1).
At operation, a cystic mass on the mesenteric side of the
cecum was found. The small intestine was distended
whereas large gut was collapsed (Fig. 2). There was
complete intestinal obstruction at the level of the cyst as
appreciated by a failure of passage of the intestinal
contents distally. The cystic mass was opened and about
50cc mucous drained. This resulted in sudden passage of
intestinal contents into the ascending colon. The posterior
wall of the cyst was being shared with the cecum.
Mucosal stripping was performed after eversion. Patient
made an uneventful recovery and discharged home on 4th
post-operative day. Histopathology confirmed it as cecal
duplication.
Figure 1: Abdominal radiograph suggestive of mass effect and
intestinal obstruction.
APSP J Case Rep 2011; 2: 11
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DISCUSSION
Duplications of the alimentary tract are rare anomalies.
They may be of cystic or tubular variety with an intimate
contact with the adjacent gut; smooth muscles in their
wall and mucosa resemble that of intestine. Most
common duplications occur along the ileum. Colonic
duplications are rare (13%); cecal duplications are even
rarer as only less than 20 cases have been reported in
English literature [1-3].
They usually present within first two years of life in 80%
of cases but has been reported in adults as well. Cecal
duplications usually present with acute intestinal
obstruction. They communicate with gut in less than 20%
of cases where the presentation may be with bleeding per
rectum if an ectopic gastric mucosa is present in it.
Cecum is also a site where some colonic tubular
duplications are intimately attached [1,2,3,5,6].
Ultrasound, CT scan, contrast bowel studies, technetium
99m radionuclide scan, and diagnostic laparoscopy are
important tools for preoperative diagnosis; however, cecal
duplications are diagnosed at operation in most of the
cases. Our preoperative diagnosis was mesenteric cyst
with a differential of alimentary tract duplication, not
specifically of cecal origin.
Figure 2: Operative view of the cecal duplication (arrow). The
ascending colon was collapsed.
1

The mechanism of obstruction in case of cecal 3.
duplication depends upon the amount of mucous in its
lumen. Fully loaded cecal duplication can obstruct the 4.
lumen of the normal cecum and may result in acute
intestinal obstruction as in our case. Simple drainage of 5.
the mucus relieved obstruction in the index case.
Various surgical procedures have been employed to deal 6.
with such lesions. Cecal duplications are commonly
managed by limited right hemicolectomy and ileocolic
anastomosis [1-5]. In our case drainage of the mucous
relieved obstruction therefore anterior wall was
completely excised and mucosal stripping was performed
on the common wall. The common wall appeared thin
and redundant thus plicated along with the margins of the
residual anterior wall of the duplication.
REFERENCES Children’s Hospital & The Institute of Child Health Lahore,
1. Keum S, Hwang M, Na J, Yu S, Kang D, Oh Y. Intestinal
obstruction caused by duplication cyst of the cecum in a
neonate. Korean J Pediatr 2009;52:261-4.
Received on: 15-02-2011
2. Lund DP. Alimentary tract duplications. In: O’Neill JA,
Rowe MI, Grosfeld JL, Fonkalsrud WE, Coran AG. Editors.
Pediatric Surgery, 6th ed, Philadelphia: Mosby,
2006:1389-99.
How to cite
Ijaz L, Husnain M, Malik SI, Mirza B. Cecal duplication cyst presenting as acute intestinal obstruction in an infant. APSP J Case Rep
2011;2:11
APSP J Case Rep 2011; 2: 11 2
Ijaz et al, Cecal Duplication Cyst
Oudshoorn JH, Heij HA. Intestinal obstruction caused by
duplication of the cecum. Eur J Pediatr 1996; 155:338-40.
Shah A, Shah A. Diagnostic dilemma of cecal duplication.
Indian Pediatrics 2004;41:749-50.
Martins JL, Cury ED, Petrilli AS, Martins ECS, Neto G.
Cecal duplication causing disappearing abdominal mass in
an infant. J Pediatr Surg 2001;36:1581-3.
Sharif M, Iqbal S, Mirza B, Ijaz L, Saleem M, Sheikh A.
Atresia of colonic tubular duplication: a case report.
[Online]. 2009 July 01 [cited 01-03-2011]; Available from:
http://www.babysurgeon.com/pdf/Atresia-of-colonic-
tubular-duplication.pdf
Corresponding Author: BILAL MIRZA
Address: Department of Paediatric Surgery, The
Pakistan.
Email: blmirza@yahoo.com
Accepted on: 05-03-2011
http://www.apspjcaserep.com © 2011 Mirza et al,
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