Gastrointestinal duplication is an infrequent congenital disorder, presenting a mucosal-covered muscle layer.The clinical picture is usually characterized by epigastric pain, vomiting and palpable abdominal mass, which may present in other more frequent diseases. Diagnostic confirmation often requires complementary imaging exams and treatment is always surgical.
Here is the case report of a 2 month-old girl, delivered by cesarean section due to induction failure at 39 weeks of gestational age, Patient was on exclusive breastfeeding since birth presenting with frequent post-feeding regurgitation, but maintaining a weight gain of 21 g per day. At 77 days of age, she developed bulky, non-bilious postprandial vomiting, leading to grade II dehydration. Child was hospitalized and kept on enteral feeding through a nasogastric tube.
The barium swallow test (esophagogram study) showed narrowing pylorus.
Ultrasound examination showed unilocular thick-walled cystic lesion, with anechoic content measuring 3.3 × 2.4 × 3.8 cm (15mL) near the first duodenal portion indicating duodenum compression and obstruction. This lesion had as its main hypothesis an enteric duplication cyst. Exploratory laparotomy was performed, with transverse supraumbilical incision in the right hypochondrium. A turgid cyst was identified in the pylorus region near the posterior wall, and the presence of ectopic pancreatic tissue was also found. Cyst had hyaline mucoid content. Marsupialization and mucosectomy were performed and the material sent for histological analysis.
In summary, gastrointestinal duplication is a rare congenital disorder. Gastric duplication is even rarer, with less than 50 reported cases. When it is located in the pylorus, it presents with earlier symptoms, including in the neonatal period, simulating cases of pyloric hypertrophic stenosis, as in the case reported here.Clinical examination accompanied by complementary exams help to determine the most accurate diagnosis, allowing appropriate treatment with total surgical resection of the lesion, when possible, avoiding future complications including malignant tumors.
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