Introduction
Cecal duplication cysts are an exceptionally rare congenital anomaly, with most cases diagnosed in early childhood. The presentation in adults is unusual and often poses a diagnostic and therapeutic challenge. This case report describes the laparoscopic resection of a cecal duplication cyst in a 28-year-old male, emphasizing diagnostic workup, surgical strategy, and postoperative outcome, and contributing to the growing evidence supporting minimally invasive management in selected adults.
Clinical Presentation
The patient, a 28-year-old man with no significant medical history, presented with intermittent right lower quadrant discomfort and vague abdominal fullness. Physical examination was largely unremarkable, with mild tenderness in the right lower abdomen. There were no alarm features such as weight loss, fever, or gastrointestinal bleeding. Routine laboratory tests were within normal limits. The non-specific clinical picture necessitated imaging studies to delineate an underlying structural anomaly.
Imaging and Differential Diagnosis
Contrast-enhanced computed tomography (CT) revealed a well-circumscribed, cystic lesion with a discrete communication to the cecal lumen. Magnetic resonance imaging (MRI) provided superior soft-tissue characterization, suggesting a duplication cyst lined by mucosa and surrounded by smooth muscle, consistent with enteric duplication rather than other cystic entities. Differential diagnoses included enteric cysts, mesenteric cysts, cystic neoplasms, and inflammatory or infectious processes. The imaging pattern, together with the lesion’s localization at the ileocecal region, raised a high index of suspicion for a cecal duplication cyst, prompting surgical planning.
Indication for Surgery
Although many duplication cysts can be managed conservatively or observed if asymptomatic, surgical excision is generally recommended for symptomatic lesions, potential malignant transformation, and to establish a definitive diagnosis. In this adult patient, laparoscopic resection offered several advantages: reduced postoperative pain, shorter hospital stay, faster recovery, and excellent visualization of the right colon. The goal was complete excision of the cyst while preserving the integrity of the cecum and surrounding bowel.
Operative Technique
The procedure was performed under general anesthesia using a standard laparoscopic approach. After establishing pneumoperitoneum, a four-port configuration provided optimal access to the right lower quadrant. Intraoperative findings confirmed a cystic lesion arising from the anteromedial aspect of the cecum with a small patent communication to the cecal lumen. The cyst was carefully dissected from the serosa and intestinal wall while preserving adjacent structures. A segmental resection of the cystic portion with primary anastomosis of the cecal wall was performed using extracorporeal techniques when necessary. The specimen was retrieved in a specimen bag to prevent contamination. Hemostasis was achieved, and the abdomen was closed in standard fashion.
Intraoperative Considerations
Key considerations included ensuring complete excision of the cyst to prevent recurrence, maintaining mucosal integrity to avoid leakage, and assessing the nearby ileocecal valve and mesenteric vessels. Laparoscopy provided magnified visualization, enabling precise dissection and minimizing trauma to surrounding tissues. No intraoperative complications were encountered, and operative time was within the expected range for minimally invasive management of intestinal duplications.
Postoperative Course
The patient’s recovery was uneventful. He resumed oral intake on postoperative day one, experienced minimal pain, and was discharged home on postoperative day two. Histopathology confirmed a cecal duplication cyst lined by enteric mucosa with a well-developed smooth muscle coat, without signs of dysplasia or malignancy. At follow-up visits, the patient reported resolution of symptoms and maintained normal bowel function without need for ongoing surveillance beyond standard postoperative care.
Discussion
Adult presentation of cecal duplication cysts is rare and can mimic other right-sided abdominal conditions. Imaging modalities such as CT and MRI are instrumental in characterizing the lesion, guiding preoperative planning. Surgical management—preferably via laparoscopy—offers definitive treatment, rapid recovery, and minimal functional impact. The current case adds to the body of literature supporting laparoscopic resection as a safe and effective approach for cecal duplication cysts in adults, when anatomy allows and there is no evidence of malignant transformation. Long-term follow-up remains prudent, although recurrence after complete excision is uncommon.
Conclusion
In selected adult patients, laparoscopic resection of a cecal duplication cyst is a feasible and advantageous procedure. Early suspicion, accurate imaging, and meticulous minimally invasive technique can lead to excellent outcomes with low morbidity. This rare case reinforces the role of laparoscopy in modern colorectal surgery and highlights the importance of considering congenital anomalies in the differential diagnosis of right lower quadrant masses in adults.
