Introduction
Cecal duplication cysts are among the rarest congenital anomalies of the alimentary tract. Most cases are diagnosed in early childhood, often presenting with nonspecific abdominal symptoms or acute complications. The occurrence of a cecal duplication cyst in a 28-year-old adult is exceedingly uncommon and presents unique diagnostic and therapeutic challenges. This case report discusses the laparoscopic resection of a cecal duplication cyst in an adult patient, highlighting clinical features, imaging findings, operative technique, and postoperative outcomes.
Background and Clinical Presentation
Duplication cysts of the gastrointestinal tract are characterized by a smooth muscle coat and an epithelial lining resembling a segment of the alimentary tract. Cecal duplications complain with acute right lower quadrant pain, persistent vomiting, or incidental discovery during imaging for unrelated issues. In adults, the differential diagnosis includes appendiceal pathology, mesenteric or omental cysts, inflammatory masses, or neoplasms. The patient in this report presented with vague abdominal discomfort and intermittent pain without signs of systemic infection. A composite of history, physical examination, and targeted imaging guided the diagnostic process toward a probable cecal duplication cyst rather than a simple diverticular or inflammatory process.
Diagnostic Workup
Imaging plays a pivotal role in identifying duplication cysts. Ultrasonography often reveals a cystic structure with a well-defined wall, while computed tomography (CT) or magnetic resonance imaging (MRI) can delineate the relationship of the cyst to the cecum and surrounding bowel. In this case, contrast-enhanced CT demonstrated a well-circumscribed, thin-walled intraluminal/retroperitoneal cyst closely associated with the cecal wall. The lesion appeared non-enhancing with features suggestive of a duplication cyst rather than an abscess or neoplasm. Preoperative assessment also included colonoscopy, which helped to exclude intraluminal pathologies and provided supplementary visualization of the cecal mucosa. The combination of imaging findings and clinical context raised suspicion for a cecal duplication cyst and guided surgical planning toward minimally invasive management.
Surgical Approach: Laparoscopic Resection
Given the patient’s age, anatomy, and absence of acute complications, a laparoscopic approach was chosen. Laparoscopic resection offers several advantages for duplication cysts located near the cecum, including smaller incisions, faster recovery, and excellent visualization of the mesenteric and mural planes. The surgical goals were to completely excise the cyst while preserving the integrity of the cecum and adjacent ileocecal valve if feasible, and to minimize the risk of contamination or perforation.
During the procedure, standard laparoscopic ports were placed to access the right lower quadrant. The cyst was carefully dissected from the cecal serosa, ensuring complete removal of the lining and closure of any communications with the intestinal lumen. The specimen was retrieved in an endoscopic bag to prevent contamination. Intraoperative assessment confirmed the preservation of surrounding bowel segments, and reintegration of the cecal lumen proceeded without complication. The patient tolerated the procedure well, with no intraoperative or immediate postoperative complications.
Postoperative Course and Follow-Up
Postoperative recovery was notable for standard expectations after laparoscopic bowel surgery, including early mobilization, gradual advancement of diet, and effective pain control. Histopathology of the resected specimen confirmed a true duplication cyst with an intestinal mucosal lining and a smooth muscle wall consistent with a congenital duplicative structure. No malignant transformation was identified. The patient was discharged with routine postoperative instructions and scheduled for follow-up to monitor for potential recurrence or late sequelae. At the first postoperative visit, the patient reported relief from prior symptoms and had resumed normal activities.
Discussion and Clinical Implications
Adult presentation of cecal duplication cysts underscores the importance of considering congenital anomalies in the differential diagnosis of right lower quadrant pain and cystic abdominal lesions. Imaging features of duplication cysts can be subtle; hence, a high index of suspicion combined with careful radiologic interpretation is essential. Laparoscopic resection is increasingly recognized as a safe and effective modality for mature or accessible duplications, thanks to precise dissection, reduced postoperative pain, and shorter hospital stays. Pathologically, duplication cysts contain a muscular wall and mucosal lining, and thorough removal reduces the risk of infection, inflammation, or malignant change in long-standing cases.
Conclusion
This case demonstrates that laparoscopic resection is a feasible and favorable option for cecal duplication cysts in adults. Accurate preoperative diagnosis, meticulous surgical technique, and attentive postoperative care can yield excellent outcomes. Clinicians should consider congenital intestinal duplications in the differential diagnosis of atypical right lower quadrant cystic lesions in adults, and multidisciplinary collaboration remains essential for optimal patient care.
Key Takeaways
- Cecal duplication cysts, though rare in adults, should be included in differential diagnoses of right lower quadrant masses.
- Imaging and endoscopic evaluation are crucial for preoperative planning.
- Laparoscopic resection offers safe, effective management with favorable recovery.
