Jejunal duplication cyst displaying peristalsis and a five-layered appearance of the wall: a preoperative ultrasound diagnosis

Abstract

A case of preoperatively diagnosed jejunal duplication cyst displaying the characteristic five-layered appearance of the gastrointestinal tract wall and peristaltic activity is reported. Both these rare features allowed a specific diagnosis of enteric duplication to be made.

Sonographic Pitfalls in the Diagnosis of Enteric Duplication Cysts

“…As the name suggests, enteric duplication cysts are defined by their histologic appearance, which mimics that of the native gastrointestinal tract possessing an inner mucosa-submucosa layer surrounded by an outer smooth-muscle layer [1]. This finding has been seen both in vivo [5] and in vitro [6]. The characteristic sonographic appearance consists of an inner hyperechoic rim correlating to the mucosa-submucosa and an outer surrounding hypoechoic layer reflecting muscularis propria.…”

A case of perforated multiple gastric duplication cysts with five-layered appearance on ultrasonography

“…6a, b). Although there was a little mismatch between the ultrasonographic and pathologic findings with regard to the thickness of each layer, the alternating hyperechoic and hypoechoic layers of the gastric duplication cyst roughly corresponded to the anatomical structure from the endoluminal aspect: boundary echo plus mucosa, muscularis mucosa, submucosa, muscle, and serosa, respectively, as in a previous report about jejunal duplication cyst [10]. Also, US clearly revealed that the gastric duplication was contiguous with the gastric wall through the fourth hypoechoic layer corresponding to the muscle layer.…”

“…Although findings of a five-layered structure of gastrointestinal duplication cysts have been reported [10,16], to the best of our knowledge, this is the first report of the sonographic features of the five-layered structure in a gastric duplication cyst. We correlated the ultrasonographic finding of a five-layered appearance with the pathological finding (Fig.…”

“…Well described in the literature is the ''double-wall'' or ''muscular rim'' sign, which refers to the appearance of a cyst mimicking the gastrointestinal tract with an echogenic inner margin corresponding to mucosa surrounded by a hypoechoic rim of tissue representing the smooth muscle layer [7]. Identification of this sign on US has been regarded as characteristic of an enteric duplication cyst [8][9][10][11][12]. The presence of these two layers helps to exclude other cystic masses such as mesenteric or omental cysts, choledochal cysts, ovarian cysts, and pancreatic pseudocysts [13].…”

Non-communicating small intestinal duplication in a dog: a case report

“…1990). The duplicated luminal border is hyperechoic, the muscular wall is hypoechoic and the serosal layer and adjacent fat are hyperechoic (Simonovsky 1996). Potentially purulent cellular debris and haemorrhaging in the enteric duplication produce an echoic appearance contrasting with that of the mobile luminal contents.…”