History and Physical Examination
Most duplications are incidentally diagnosed. In some instances, they are diagnosed on antenatal ultrasonography. Those that are missed on antenatal ultrasonography are usually diagnosed by the second or third year of life.
Most patients present with a combination of pain and obstructive symptoms. These symptoms may be the direct effects of distention of the duplication or may be caused by compression of adjacent organs (including their associated blood supplies). In addition, abrupt hemorrhage with hemodynamic instability can be encountered in the case of a cyst lined with gastric mucosa [15] that ulcerates and eventually erodes into adjacent organs or vessels. The presentation usually depends on the location of the duplication cyst.
Chest
Duplications in the chest usually present as pulmonary symptoms or dysphagia. Pain may be noted. The lesion is often picked up as a cystic mass on a chest x-ray.
Abdomen
Pain and vomiting are the usual symptoms associated with duplications in the abdomen.
Duplications arising from the foregut, besides causing pain and vomiting, can give rise to bleeding and perforation from ulceration. They may also present as gastric outlet obstruction and therefore must be differentiated from hypertorophic pyloric stenosis and other causes of gastric outlet obstruction.
Duplications arising from the midgut can cause pain in the right lower quadrant and may be confused with appendicitis. In some cases, the duplication cyst may cause intussusception.
Duplications arising from the hindgut can present as a secondary opening in the perineum; in females, they can also form a rectovaginal fistula. Symptoms in these cases can range from obstruction to incontinence. Mass effect from these cysts, which tend to be giant, can also cause obstruction of the ureters.
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Illustration depicting the many locations where alimentary tract duplications may be found.
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Abdominal radiograph of an infant with acute onset of bilious vomiting and abdominal distention secondary to a duplication cyst at the terminal ileum.
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A small ileal duplication cyst causing complete obstruction of the small bowel (same patient as in the image above).
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The intimate association of the jejunal duplication cyst with normal jejunum requires a limited small-bowel resection as definitive surgical therapy.
