Isolated Colonic Duplication Cyst: An Unusual Cause of Abdominal Pain

Excerpt

An 18-year-old girl with a 3-year history of intermittent lower right abdominal dull pain was referred to our hospital. Similar episodes in the past had spontaneously resolved, but her symptoms had been progressing recently. She did not have nausea, vomiting, or bowel habit changes. Her medical history was unremarkable. On examination, she was afebrile. Her abdomen was soft, with right lower quadrant–localized–tenderness. Her laboratory results, including white blood cell count and C-reactive protein and tumor marker levels, were all normal. A computerized tomography scan demonstrated an 8-cm cystic tumor in the right abdomen. The tumor had a slightly enhancing wall with homogeneous fluid inside. It was an isolated structure without communication with the adjacent organs (Fig. 1a). Magnetic resonance imaging (MRI) revealed low signal intensity on T1-weighted images (Fig. 1b) and very high-intensity on T2-weighted images (Fig. 1c). Surgical intervention was recommended to obtain a definitive diagnosis and to treat the probable recurrent abdominal pain. Diagnostic laparoscopy revealed a retroperitoneal tumor with its own blood supply from the adjacent retroperitoneum rather than from the mesenteric vessels (Fig. 2). Therefore, she underwent subsequent laparoscopy-assisted tumor excision without bowel resection. The tumor wall was thick and rubbery. On cut section, the cystic mass was found to contain serous fluid. Histopathological examination revealed colonic mucosa and well-formed smooth muscular layers, consistent with the findings of isolated colonic duplication cysts (Fig. 3). The postoperative course was uneventful, and then she was discharged home on postoperative day 5. On subsequent follow-up, the patient reported complete resolution of her abdominal pain.

…