An effective method for preoperative distinguishing Gastric duplication cysts and Adrenal cysts in children

Abstract

Background: Gastric duplication cysts (GDC) are a rare congenital disease primarily found in the left adrenal region in neonates and children. Due to a lack of typical clinical manifestations, GDCare often preoperatively treated as adrenal cysts (AC). Methods: We retrospectively report six child cases of retroperitoneal cysts presenting as left adrenal masses between January 2012 and January 2022. Patients aged from 10 months to 10 years, including three females and three males, were all treated by surgery and discharged without serious complications. Clinical data such as medical history, clinical manifestations, auxiliary examination, operation process, and postoperative pathological diagnosis were examined in detail. Results: Only one male had mild epigastric pain that could be relieved spontaneously, and the rest had no obvious clinical manifestations. Endocrinological evaluations indicated no positive findings. The stomach-cyst distance in computerized tomography (CT) scans and cyst-kidney distance in ultrasound scans were significantly different in the patient with GDC. All patients underwent surgical resection and were preoperatively diagnosed with a left AC. One patient underwent open cystectomy, and the others underwent laparoscopic cystectomy. Surgical access was transperitoneal in five patients and retroperitoneal in one patient. Mean operative time was 129.7±15.46 min, mean oral feeding time was 9.0±2.58hours, and mean length of hospital stay was 6.5±0.96 days. No serious complications were observed, and their pathological diagnosis was AC, except for one case of GDC. All patients recovered and had no complications during follow-up. Conclusion: GDC is easily misdiagnosed as left AC.Accurate diagnoses are mainly based on intraoperative findings and postoperative pathological examinations. However, in addition to gastrointestinal symptoms, such as abdominal pain and vomiting, the stomach-cyst distance in CT scans and cyst-kidney distance in ultrasound scans can be used as critical evidence for preoperative diagnosis GDC or AC. Laparoscopic surgery is safe and effective, and a transperitoneal approach is recommended for GDC.