6. Provisional diagnosis - Tubular ileal duplication
Gastrointestinal duplications are rare congenital anomalies and can be detected in any
part of the GI tract from the oral cavity to the anus, most frequently identified in the
small intestine and are most common in the ileum.
In 1937, Ladd defined GI duplication as the presence of a well-developed smooth
muscle layer and an inner epithelium similar to digestive tract in close proximity to
the gastrointestinal system
Approximately 80% of cases present clinically before age of two years . The most
common symptoms include recurrent abdominal pain, nausea, vomiting and
abdominal palpable mass . The preoperative diagnosis of GIS duplication is difficult
and radiologic examinations may not be sufficient for an accurate diagnosis in all the
cases. Obstruction, bleeding, perforation, volvulus, intussusception and malignancy
may be seen in adults with gastrointestinal duplication
7. In our case, the duplication was located in the ileum. Its incidence is generally one in
every 10,000 live births . It may be of the cystic or tubular type, but the tubular type
is rarer . In our case, the duplication was of the tubular type. Unlike Meckel’s
diverticulum, they are located within the mesentery.
In case of unexplained abdominal pain, gastrointestinal duplications should be kept
in mind as part of differential diagnosis even in adults, and once recognized
complete resection is the appropriate treatment due to the risk of malignancy.
8. CASE 2
60Y/F WITH PAIN IN ABDOMEN.
OUTSIDE USG REVEALED CYSTIC LESION IN PERIPANCREATIC
REGION ? PANCREATIC PSEUDOCYST.
USG DONE AT OUR CENTRE REVEALED IMPERCEPTIBLE WALL
CLEAR CYST ANTEROINFERIOR TO PANCREAS WITH PANCREAS
APPEARING NORMAL.
THUS MRI ABDOMEN WAS PERFORMED FOR FURTHUR
EVALUATION.
9.
10.
11.
12. PROVISIONAL DIAGNOSIS- CYSTIC LYMPHANGIOMA OF MESENTERY
Lymphangiomas are benign lesions of mesenchymal origin with lymphatic differentiation.
Approximately 95% occur in the neck and axilla, while the remaining 5% are found in the
chest and abdomen. Lymphangiomas of the abdomen are rare but have been reported in
the mesentery, retroperitoneum, gastrointestinal tract and intra-abdominal solid viscera.
The clinical presentation of lymphangiomas varies from incidental discovery on imaging
to presenting with an acute abdomen. Most, however, remain asymptomatic until they
grow to a large size. Mesenteric lymphangiomas, in particular, can result in complications
such as intestinal obstruction or volvulus leading to infarction. This case report
documents a lymphangioma of the small bowel mesentery, discovered on ultrasound and
initially thought to represent a pancreatic pseudocyst. The mass was subsequently
delineated on further imaging.
13. Typical imaging findings of lymphangioma are those of a thin-walled, multiloculated
cystic lesion lacking solid components or mural nodularity. Calcifications are
uncommon. The walls and septae are typically non-enhancing or minimally enhancing.
ON MRI they show T2 high signal fluid, while signal loss may be visualized on chemical
shift T1-weighted imaging due to microscopic fat content from chylous fluid – this is a
very suggestive finding for a lymphangioma occurring in 20–30% of cases, although
rarely it may be found in other limited differentials such as lymphoceles or
lymphoepithelial cysts. Lymphangiomas may either be stable in size or show slow
progressive growth. They typically do not show any significant mass effect and
generally insinuate around adjacent structures. Lymphangiomas are not associated
with local invasion, enlarged adenopathy, or organ metastases. The imaging algorithm
for the work-up of lymphangiomas would depend on the local resources and
availability of imaging modalities such as US, CT, and MRI. Treatment options include
fine needle aspiration, sclerotherapy, or surgical excision and to date, radical excision
remains the definitive treatment, in particular, to prevent recurrence.
14. • CASE 3
• 75 Y MALE WITH COMPLAINTS OF DYSPHAGIA AND
SOMETHING STUCK UP IN CHEST .FOR PAST FEW YEARS.
• MULTIPLE INVESTIGATIONS DONE IN PAST INCLUDING
UPPER GI ENDOSCOPY,ESOPHAGEAL MANOMETRY AND
ALSO HRCT CHEST.NOTHING CONCUSIVE WAS FOUND IN
THESE INVESTIGATIONS.
• PATIENT WAS REFERRED FOR BARIUM SWALLOW
