Introduction
Gastric duplication (GD) is a relatively uncommon congenital disorder of the gastrointestinal tract, with a low occurrence rate of 17 cases per one million people. Patients with GD may experience symptoms such as abdominal pain, vomiting, abdominal mass, and weight loss, but the lack of specific clinical features, imaging findings, and laboratory tests make it difficult to diagnose. This leads to a high chance of missed diagnosis or misdiagnosis. Currently, the diagnosis of GD requires a combination of surgical examination and pathology analysis. Due to the potential for serious complications such as bleeding, perforation, obstruction, and malignant transformation, most experts recommend prompt removal of GD once it is diagnosed.
What Causes Gastric Duplication?
Gastric duplication is a congenital disorder, which means it is present at birth. The exact cause of gastric duplication is not well understood, but it is believed to be the result of abnormal gastrointestinal tract development during embryonic development. Gastric duplication is thought to occur when the gut fails to fully separate into distinct layers during embryonic development, resulting in the formation of a duplication cyst.
It is unknown why some individuals develop gastric duplication, and others do not. Genetic factors may play a role, but most cases of gastric duplication are not inherited. Gastric duplication is a rare condition, and it is not associated with any known environmental factors or lifestyle habits.
What Are the Clinical Features of Gastric Duplication?
The signs and symptoms of gastric duplication can vary depending on the size and location of the duplication, as well as whether or not it is connected to the rest of the stomach. Some common symptoms include:
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Abdominal Pain: This can be caused by the pressure of the duplication on surrounding organs or by inflammation within the duplication.
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Nausea and Vomiting: These symptoms can occur if the duplication blocks the flow of food through the stomach.
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Difficulty Swallowing: This can occur if the duplication is located near the esophagus and blocks the flow of food.
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Gastric Outlet Obstruction: This occurs when the duplication blocks the opening of the stomach, leading to difficulty passing food.
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Palpable Abdominal Mass: A doctor can feel this during a physical examination if the duplication is large enough.
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Weight Loss: This can occur if the duplication blocks the passage of food through the stomach, leading to malabsorption and malnutrition.
Some individuals with gastric duplication may not have any symptoms at all, and the condition may be discovered incidentally during a medical examination for another reason.
Gastric duplications can also result in serious complications, including obstruction, twisting, perforation, bleeding, and even malignant transformation. Gastric duplication cysts that become cancerous have a poor outcome, so it is crucial to recommend surgical removal once the condition is diagnosed.
How Is Gastric Duplication Diagnosed?
The diagnosis of gastric duplication can be challenging due to the lack of specific clinical manifestations, imaging findings, and laboratory tests. The key requirements for diagnosing GD have been outlined by Rowling (a) the cyst's wall is connected to the stomach wall; (b) the cyst is surrounded by smooth muscle that is continuous with the muscle of the stomach; and (c) the cyst is lined with digestive epithelium, which may not always be of the gastric type, it could be colonic, jejunal, or any other type of gut lining. GD typically shares a common wall and blood supply with the stomach, which sets it apart from the diverticulum. Apart from that, several diagnostic methods are used to confirm the diagnosis, including:
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Physical Examination: A doctor may be able to feel a mass in the abdomen if the duplication is large enough.
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Imaging Studies: Various imaging modalities such as ultrasound, CT scan, and MRI can be used to identify the duplication and determine its size and location.
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Endoscopy: A thin tube with a camera on the end (endoscope) is inserted through the mouth and into the stomach, allowing the doctor to examine the inside of the stomach and identify the duplication.
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Biopsy: Tissue samples may be taken from the duplication for pathological analysis to confirm the diagnosis.
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Surgical Exploration: In some cases, surgical exploration may be necessary to confirm the diagnosis and remove duplication.
What Are the Treatment Options for Gastric Duplication?
The treatment for gastric duplication is the surgical removal of the cyst. The type of surgery will depend on the duplication's size, location, and complexity.
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Laparoscopic surgery: A minimally invasive surgery performed through small incisions in the abdomen. This is a common approach for small, uncomplicated gastric duplication cysts.
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Open Surgery: A larger incision is made in the abdomen to remove the cyst. This may be necessary for larger or more complex cysts.
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Resection: Depending on the size of the cyst and its location, the cyst can be resected, the gastric wall can be closed, or a Roux-en-Y anastomosis can be done if the cyst is close to the pylorus.
Gastric duplication with malignancy carries a poor prognosis. Therefore, surgical resection must be strongly suggested once the disease is confirmed. After surgery, patients may need to follow a special diet and take antibiotics to prevent infection. Close monitoring by a specialist is necessary post-surgery to ensure proper healing and recovery.
Conclusion
In conclusion, Gastric duplication is a rare congenital disorder of the gastrointestinal tract, which affects approximately 17 cases per one million people. The exact cause of gastric duplication is not well understood, but it is believed to result from abnormal gastrointestinal tract development during embryonic development. Gastric duplication can lead to serious complications such as obstruction, twisting, perforation, bleeding, and malignant transformation; therefore, surgical removal is recommended once the condition is diagnosed. The diagnosis of gastric duplication can be challenging due to the lack of specific clinical manifestations, imaging findings, and laboratory tests. The treatment options for gastric duplication include laparoscopic surgery and open surgery, depending on the cyst's size, location, and complexity. After surgery, patients may need to follow a special diet and take antibiotics to prevent infection, and close monitoring by a specialist is necessary to ensure proper healing and recovery.
