Introduction
Cecal duplication cysts are rare congenital anomalies of the gastrointestinal tract. Most cases occur in early childhood, with adults representing a very small fraction of presentations. The clinical features are diverse and can mimic other right‑sided abdominal conditions, leading to diagnostic challenges. This case report documents a laparoscopic resection of a cecal duplication cyst in a 28-year-old male, highlighting diagnostic considerations, surgical strategy, and postoperative outcomes.
Clinical Presentation and Diagnostic Workup
The patient, a previously healthy 28-year-old man, presented with nonspecific right lower quadrant discomfort evolving over several months. There was no history of weight loss, fever, or overt gastrointestinal bleeding. Physical examination was unremarkable aside from mild tenderness in the right iliac fossa. Routine laboratory tests were within normal limits.
Initial imaging with abdominal ultrasound suggested a cystic lesion near the cecum. Given ambiguity, contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) were performed. The imaging showed a well‑defined cystic mass adjacent to the cecal wall, with no communication to the bowel lumen and no surrounding inflammatory changes. The radiologic differential diagnosis included enteric duplication cyst versus mesenteric or omental cyst. To refine localization and assess feasibility for minimally invasive surgery, endoscopic evaluation and cross-sectional imaging were correlated. Ultimately, a decision for diagnostic laparoscopy with therapeutic resection was made.
Preoperative Planning
Key considerations before surgery included ensuring careful assessment of the cyst’s relationship to the cecum and ileocecal valve, >risk of shared blood supply, and potential communication with the intestinal lumen. Informed consent discussed the possibility of conversion to an open procedure if needed for safety or oncologic assessment. A multichannel laparoscopic approach was planned, using small-bowel and mesenteric dissection techniques to preserve surrounding tissues and minimize postoperative complications.
Surgical Technique
Under general anesthesia, a laparoscopic approach was undertaken with standard ports placed to optimize access to the right lower quadrant. Exploration confirmed a cystic lesion closely associated with the cecal wall, without obvious invasion into surrounding organs. Careful dissection separated the cyst from the serosa while preserving the integrity of the cecal lumen and the ileocecal valve. The cyst was excised in its entirety with a margin of normal tissue to minimize recurrence risk.
Intraoperative assessment included inspection for additional duplications or anomalies within the terminal ileum. The cyst’s base was managed with precision suturing to ensure hemostasis and a secure serosal closure. A meticulous mesenteric handling technique was employed to maintain adequate perfusion to the remaining bowel and to obviate postoperative stricture formation. The specimen was retrieved in an endoscopic bag through a small incision, and the integrity of the bowel was confirmed with air insufflation and gentle palpation.
Postoperative Course
The patient tolerated the procedure well and recovered without major complications. Early oral intake was initiated, and pain was controlled with routine analgesia. No signs of infection, leakage, or obstruction were observed. The patient was discharged home on postoperative day two with standard postoperative instructions and a plan for routine follow‑up. Pathology confirmed a benign duplication cyst with no evidence of dysplasia or malignancy.
Discussion
This case underscores several important points about cecal duplication cysts in adults. First, clinical presentation can be nonspecific, often leading to delayed diagnosis. Second, imaging studies may suggest alternative diagnoses; however, laparoscopy provides both diagnostic confirmation and therapeutic capability, enabling resection with minimal invasiveness when appropriate. Third, preserving the ileocecal valve and adjacent bowel while ensuring complete excision remains the key aim to prevent complications such as obstruction or recurrent disease. Although rare, adult cases expand the spectrum of surgical management options and demonstrate that laparoscopic resection is feasible and safe in well-selected patients.
Conclusion
In adults presenting with a suspected cecal duplication cyst, laparoscopic resection offers a definitive treatment with favorable short-term outcomes. This case contributes to the growing body of literature supporting minimally invasive strategies for rare congenital anomalies in adults and reinforces the importance of careful intraoperative assessment and meticulous technique.
Keywords
cecal duplication cyst, duplication cyst, laparoscopic resection, adult, case report, right lower quadrant pain, minimally invasive surgery
