Gastric Duplication Treated by Laparoscopy in a Child

Yoo Shin Choi, MD, Beom Gyu Kim, MD, Hyun Kang, MD

Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea (Drs. Choi and Kim). Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea (Dr. Kang).

ABSTRACT

Duplication of the alimentary tract is an uncommon occurrence (1 of 4500 births) in pediatric patients and can affect any portion of the gastrointestinal track. The gastric duplication cysts represent 4% to 8% of all alimentary track duplications. Symptoms often occur by 2 years of age and can include nausea, vomiting, hematemesis, and vague abdominal pain. Gastric duplication cysts are typically found on the greater curvature or posterior stomach wall, are more commonly cystic than tubular, and although they are attached to the stomach, they do not typically communicate with the lumen. The treatment of choice is surgical resection.

An 8-year-old boy with intermittent upper abdominal pain visited our hospital due to acute onset pain in the lower abdominal region. Acute appendicitis with suspicion of gastric duplication was detected on computed tomography scan. Laparoscopic appendectomy was performed first. After the patient’s recovery from appendectomy, we evaluated the suspected gastric lesion on the computed tomography scan. An upper gastrointestinal study revealed a communicating form of gastric duplication at the gastric greater curvature. Laparoscopic partial gastric resection was performed. In the operative field, severe adhesion between the stomach greater curvature and the surrounding tissues was observed, likely due to chronic inflammation. The suspected area of gastric duplication could be viewed by the unaided eye and identified by touch with the laparoscopic instrument. We performed a partial gastrectomy, with attachment of normal gastric tissue with a linear stapler. The patient was able to eat 2 days after the surgery and was discharged after 5 days without any complications.

Key Words: Communicating, Duplication cyst, Stomach.