Publication Date

11-2025

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Abstract

Introduction Enteric duplication cysts (EDCs) are rare congenital malformation formed during embryonic development of the gastrointestinal tract. Symptoms may include vomiting, abdominal distension, palpable abdominal mass, or bleeding but may vary based on location of the lesion [1]. We present a case of a 9-year-old-male with presented with recurrent rectal bleeding and had abnormalities on small bowel capsule which were diagnosed as enteric duplication cyst on exploratory laparoscopy. Case This is a 9 year old male with a history of persistent iron deficiency anemia, gallstones s/p cholecystectomy and recurrent hematochezia. Patient was initially admitted for recurrent red bloody stools and fatigue. His hemoglobin on admission was 8.1. Fecal calprotectin was elevated to 927. Meckel’s scan negative. Esophagogastroduodenoscopy and colonoscopy completed which showed mild superficial chronic gastritis but were otherwise normal. Small bowel capsule was initiated and normal but was not completed. He was discharged home on high dose proton pump inhibitor (PPI) and iron supplement. Hemoglobin on discharge was 8.4 He had follow up with GI about 1 month after this admission. He was doing well with no recurrent bloody stools. Hemoglobin was 12.7. PPI was decreased to once daily. About one month after clinic visit, he was re-admitted for recurrent bloody stools and fatigue. Hemoglobin on admission was 8.7. During this admission, magnetic resonance enterography (MRE) was negative. Nuclear medicine gastrointestinal blood loss imaging was negative with no active bleeding. EGD and colonoscopy repeated and visually normal. No biopsies obtained. Repeat small bowel capsule placed. Hemoglobin on discharge 10.3. Small bowel capsule now showing an area of narrowing, mucosal disruption, and ulceration concerning for a short-segment stricture. There is erythema/mucosal disruption without active bleeding in the distal 1/3 of the small bowel. There is a double lumen appearance with surface ulceration potentially concerning for a Meckel’s diverticulum. There are scattered areas of erythema in the distal small bowel. Dilated lacteals noted in the distal 2/3 of the small bowel. Double balloon enteroscopy vs surgery consult was recommended for further evaluation of these findings. He was again admitted about 1 month later for melena. Hemoglobin 9.6. Exploratory laparoscopy completed and visualized a large conglomeration of hypervascular bowel with small bowel coming in and out of it and adherence to the mesentery proximal to terminal ileum. This was identified as enteric duplication cyst. Patient tolerated the procedure and recovered well. Pathology identified it as benign enteric cystic lesion with mucosal ulceration consistent with an enteric duplication cyst. There was focal presence of oxyntic type gastric mucosa. At surgery follow up visit, he was doing well with stable hemoglobin. Discussion EDCs are congenital malformations of the GI tract that may cause a variety of abdominal symptoms including pain, vomiting, or bleeding. They are typically found in the distal ileum with an incidence of 4500-12500 but may occur anywhere along the GI tract [2]. EDC must have epithelial lining containing the mucosa of the GI tract, an envelope of smooth muscle and an attachment to the GI tract [1]. Most EDCs are diagnosed prenatally but if undetected, they can gradually increase in size and cause worsening obstruction, bleeding or ulceration. Ultrasound is the imaging technique of choice and will show the presence of a cyst with a “double-wall” or “muscular rim” sign. Advanced imaging such as computed tomography (CT) or magnetic resonance can also be used but these are less preferred given cost, radiation exposure or need for sedation. In a study by Okur et al., (2014), out of 32 pediatric cases of EDCs described, 28 were diagnosed with ultrasound and CT was performed in 21 patients [2]. In our case, MRE did not show evidence of an EDC.

Disciplines

Gastroenterology | Pediatrics

Notes

Presented at the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) 2025 Annual Conference; Chicago, IL; November 5-8, 2025.

Unclear Source of Gastrointestinal Bleeding: Utilizing Small Bowel Capsule to Detect an Enteric Duplication Cyst

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