Intestinal duplication revealed by posterior reversible encephalopathy syndrome

Abstract

We report a unique case of intestinal duplication detected on posterior reversible encephalopathy syndrome (PRES) in a 13-year-old girl. She was admitted to the pediatric Emergency Department because of generalized seizures. Radiological assessment revealed a large, well-defined, thick-walled cystic lesion in the mid abdomen, suggestive of duplication cyst associated to a PRES. Exploration confirmed the diagnosis of ileal duplication cyst, and the mass was resected. The postoperative course was uneventful. Both hypertension and neurological dysfunction resolved after the mass resection. A followup brain magnetic resonance imaging was performed 9 months later and showed complete resolution of the cerebellar changes. Although extrinsic compression of the retroperitoneal structures has not been reported in the literature as a complication of duplication cyst, we strongly believe that this is the most logical and plausible hypothesis that would explain the pathogenesis of PRES in our patient.

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

“…In this research, we found that while the pathology leading up to the procedure, the therapy, and the sedation used during the procedure were hypothesized to be in relation to the onset of PRES, in fact there does not seem to be a direct correlation with one pathology versus another. We have identified cases of postoperative PRES in patients treated for gastrointestinal pathology [27,30,47], gynecologic pathology [12], and even urologic pathology [31,48]. Several anesthesiologic reports [12,27,31,50] on PRES have argued that the major causative factor could be suboptimal pressure control in hypertensive patients [25,26].…”