What's your call?
The child was born in a rural hospital in Nigeria. His mother had an unremarkable pregnancy and normal vaginal delivery. She was well and reported taking only routine prenatal vitamins with folic acid and supplements of iron and vitamin B complex. There was no family history of congenital malformations. No antenatal ultrasonography was done during the pregnancy.
The mass was present since birth. The boy was ultimately brought to our children's emergency department at 5 days of age for assessment. His parents were uneducated and very poor, which probably accounted for the delay in their following up the referral for surgical consultation. The boy was otherwise well, in no distress, with an unremarkable examination except for the umbilical hernial mass. The mass protruded from the umbilical ring to the left of the umbilical stump. A provisional diagnosis of gastroschisis was made.
Intraoperatively, however, the mass was noted to have no connections to the stomach, transverse colon or umbilical ring. Instead, it was found to arise from the omentum between the greater curvature of the stomach (S) and the transverse colon (TC) (Fig. 1). The mass was excised and was found to contain a thick, gelatinous, greenish-yellow substance (see Appendix 1, available online at www.cmaj.ca/cgi/content/full/175/7/739-a/DC1). Histopathology confirmed smooth-muscle lining of the cyst wall and mucinous glands (see Appendix 2, available at www.cmaj.ca/cgi/content/full/175/7/739-a/DC1). A gastroenteric duplication cyst was confirmed. The child did well postoperatively.
Gastroenteric duplication cysts are rare malformations that vary in location, size, appearance and symptoms. Although recognized since 1733, it was not until 1937 that Ladd1 introduced the term “duplication of the intestinal tract” to describe a group of congenital anomalies that share 3 characteristics: they have a well-developed coat of smooth muscle, their epithelial lining represents some part of the alimentary tract, and they are attached to some part of the alimentary tract. Duplications are either cystic or tubular in shape. The anomalies are more common in males than in females. Although this was not the case for our patient, gastroenteric duplication cysts can sometimes cause gastric outlet obstructions.