Ultrasonographic diagnosis of congenital membranous jejunal stenosis and gastric duplication cyst in a newborn: a case report
Congenital jejunal stenosis and gastric duplication cysts are very rare congenital anomalies of the gastrointestinal tract in the newborn. We present a case of congenital membranous jejunal stenosis associated with gastric duplication cysts, which was diagnosed by ultrasonography. To the best of our knowledge, this is the first report of ultrasonographic diagnosis of congenital membranous jejunal stenosis associated with a gastric duplication cyst in a newborn.
A 1-month-old Chinese baby girl presented with projectile vomiting and hyperpyrexia for 3 days. An upper gastrointestinal contrast study showed incomplete duodenal obstruction; however, ultrasonography revealed congenital membranous jejunal stenosis associated with a gastric duplication cyst. After surgical excision of the jejunal membrane and gastric duplication cyst, she recovered well with no bilious vomiting at the 1-year follow-up.
Ultrasonography is a useful tool for the evaluation of membranous jejunal stenosis and the identification of small, asymptomatic gastrointestinal duplication cysts.
KeywordsCongenital membranous jejunal stenosis Gastric duplication cyst Newborn Ultrasonography
Congenital jejunal stenosis and gastric duplication cysts are very rare congenital anomalies of the gastrointestinal (GI) tract in the newborn; the prevalence rate of jejunoileal atresia and stenosis has been reported to be between 1 in 330 and 0.9 in 10,000 live births, and stenosis occurs in 7 % of cases . The incidence of duplication cysts of the alimentary system is approximately 1 in 4500 live births , and gastric duplication cysts represent only 4 to 5 % of these cases [3, 4]. We present a case of congenital membranous jejunal stenosis associated with gastric duplication cysts, which was diagnosed by ultrasonography. The patient underwent surgery and recovered well. To the best of our knowledge, this is the first report of ultrasonographic diagnosis of congenital membranous jejunal stenosis associated with a gastric duplication cyst in a newborn.
In general, the symptoms of patients with congenital anomalies of the alimentary tract present early after birth with recurrent, progressive vomiting. Bilious vomiting indicates obstruction distal to the ampulla of Vater , which requires an immediate and correct diagnosis and surgical correction to avoid serious complications. Normally, within 3 hours of birth, the entire small bowel contains gas, whereas gas is observed in the sigmoid colon 8 to 9 hours after birth . In some patients with congenital anomalies of the GI tract causing obstructions, the proximal bowel with lesions exhibits dilatation and effusion, and the distal intestinal cavity has little or no gas, thereby creating favorable conditions for ultrasonic detection of the lesions. Furthermore, ultrasonography of the GI tract is noninvasive, simple, radiation-free, and fairly accurate for the diagnosis of GI obstruction. Therefore, ultrasonography plays a vital role in the evaluation of patients with congenital anomalies of the GI tract. Ultrasonography has been used as an alternative to barium studies in diagnosing certain congenital anomalies of the GI tract, including annular pancreas, hypertrophic pyloric stenosis, enteric duplication cysts, malrotation, and midgut volvulus . However, the use of ultrasonography for the detection and diagnosis of membranous jejunal stenosis has not been previously reported in the literature. A previous study reported that jejunoileal atresia and stenosis are difficult to evaluate . In the present case, ultrasonography revealed the mucosal diaphragm with a pinhole in the jejunum, the duodenum and proximal jejunum loops significantly dilated with fluid, and the distal small intestine deflated with little gas. Based on this case, ultrasonography may have greater importance in the evaluation of membranous jejunal stenosis, as it enables the distinction from atresia and provides excellent anatomic details for correct diagnosis and treatment planning.
Duplication cysts are rare congenital anomalies that can occur in any part of the GI tract, although the most common site is the ileum . Gastric duplication cysts represent only 4 to 5% of duplication cysts and are located along the greater curvature of the stomach, usually in the antrum [3, 4]. Possible causes of gastric duplication cysts include errors in recanalization of the alimentary tract, McLetchie’s theory of traction diverticulum formation caused by endo-ectodermal adhesions, split notochord, and partial twinning [8, 9]. On clinical examination, gastric duplication cysts can present with vague abdominal pain, vomiting, and occasionally a palpable abdominal mass; however, presentation is usually asymptomatic and therefore difficult to diagnose . In the present case, a gastric duplication cyst was incidentally diagnosed by abdominal ultrasonography. Ultrasonography showed a small cystic lesion on the greater curvature of the stomach in the left hypochondrium. Characteristic ultrasonographic features of a GI duplication cyst are a hypoechoic muscular rim surrounding an echogenic mucosa; these features are specific to gastric duplication cysts and are not seen with other cystic lesions . However, in the present case, an upper GI tract contrast study was performed, with no evidence of mass lesions. This case report illustrates the important role of ultrasonography in detecting small, unsuspected duplication cysts.
Using ultrasonography, we successfully diagnosed congenital membranous jejunal stenosis associated with a gastric duplication cyst in a newborn. This case emphasizes that ultrasonography in a baby with congenital jejunal stenosis was effective as a diagnostic modality. In addition, ultrasonography can be helpful for the accurate identification of small and asymptomatic GI duplication cysts. Ultrasonography is superior to radiography for revealing the cause of some intestinal obstructions, suggesting that babies with bilious vomiting should have a routine ultrasound for diagnosis.
Written informed consent was obtained from the patient’s legal guardian for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We are very grateful to our supervisor, Editage, and Dr Zheng Wenhui, who provided valuable guidance at every stage of the writing of this report.
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