Gastric duplication cyst: rare cause of upper gastrointestinal bleeding in a young adult, with a review of literature


  • Philip Ding Hsin Loong Department of Surgery, Taiping Hospital, Ministry of Health, Malaysia
  • Ling Li Fan Department of Surgery, Taiping Hospital, Ministry of Health, Malaysia
  • Umasangar Ramasamy Department of Surgery, Taiping Hospital, Ministry of Health, Malaysia



Duplication cysts, GIST, Laparoscopy, EUS


Duplication cyst along the alimentary canal is a congenital anomaly which is rare and usually incidentally found at endoscopy or radiological imaging. It can develop anywhere along the alimentary canal with only 4% occurrence in the stomach. Only few cases of gastric duplication cysts were reported to be symptomatic along with its complications. Diagnostic modalities include oesophageo-gastroduodenoscopy (OGDS), endoscopic ultrasound (EUS), computerized tomography (CT) scan and magnetic resonance imaging (MRI). However, the best option to confirm the diagnosis is complete resection of the lesion. We are reporting about a teenage girl whereby she presented with sudden episodes of hematemesis, which led to a syncopal attack. She also complained of intermittent central abdominal pain for a month prior to her presentation. Physical examination was unremarkable. However, her blood investigation showed a significant drop in hemoglobin. The patient had an endoscopy during which a submucosal lesion at the greater curvature was identified and the provisional diagnosis we had was a gastrointestinal stromal tumor (GIST). CT scan of the abdomen was also done showing an endoluminal cystic gastric lesion measuring approximately 2×2×2 cm. The lesion was confined to the stomach with no local infiltration of the adjacent structures. Decision was made to proceed with a laparoscopic wedge resection after outweighing the risk and benefits of surgery. Gastric duplication cyst is a rare anomaly. Despite its rarity, it should be included as a differential when we encounter a submucosal lesion due to its tendency for malignant transformation and other complications.


Johnston J, Wheatley GH, El Sayed HF, Marsh WB, Ellison EC, Bloomston M. Gastric duplication cysts expressing carcinoembryonic antigen mimicking cystic pancreatic neoplasms in two adults. Am Surgeon. 2008;74(1):91-4.

Polkowski M, Butruk E. Submucosal lesions. Gastrointest Endosc Clin N Am. 2005;15(1):33-54.

Wang B, Hunter WJ, Bin-Sagheer S, Bewtra C. Rare potential pitfall in endoscopic ultrasound-guided fine needle aspiration biopsy in gastric duplication cyst: a case report. Acta Cytol. 2009;53(2):219-22.

Chak A. EUS in submucosal tumors. Gastrointest Endosc. 2002;56(4):S43-8.

Hedenbro JL, Ekelund M, Wetterberg P. Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc. 1991;5(1):20-3.

Kim SM, Ha MH, Seo JE, Kim JE, Min BH, Choi MG et al. Gastric duplication cysts in adults: a report of three cases. J Gastric Cancer. 2015;15(1):58-63.

Zhu Y, Lihong LV, Pan W, Ren P, Han T et al. Gastric Duplication Complicated by Malignant Transformation in Adults: Report of Three Cases. J Gastrointest Dig Syst. 2015;5:374.

Scatizzi M, Calistri M, Feroci F, Girardi LR, Moraldi L, Rubio CA et al. Gastric duplication cyst in an adult: case report. In Vivo. 2005;19(6):975-8.

Rowling JT. Some observations on gastric cysts. Br J Surg. 1959;46(199):441-5.

Perek A, Perek S, Kapan M, Göksoy E. Gastric duplication cyst. Dig Surg. 2000;17(6):634-6.

Katz W, Annessa G, Read RC. Gastric duplication with pancreatic communication. Presenting as pancreatitis. Minn Med. 1967;50(8):1175-9.

Stephen TC, Bendon RW, Nagaraj HS, Sachdeva R. Antral duplication cyst: a cause of hypergastrinemia, recurrent peptic ulceration, and hemorrhage. J Pediatr Gastroenterol Nutr. 1998;26(2):216-8.

Sari S, Kara K, Verim S, Karahan N. Gastric foregut duplication cyst as a rare cause of abdominal pain. Eurasian J Med. 2012;44(3):182-4.

Kim DH, Kim JS, Nam ES, Shin HS. Foregut duplication cyst of the stomach. Pathol Int. 2000;50(2):142-5.

Bondestam S, Salo JA, Salonen OL, Lamminen AE. Imaging of congenital esophageal cysts in adults. Gastrointest Radiol. 1990;15(4):279-81.

Rice CA, Anderson TM, Sepahdari S. Computed tomography and ultrasonography of carcinoma in duplication cysts. J Comput Assist Tomogr. 1986;10(2):233-5.

Takahara T, Torigoe T, Haga H, Yoshida H, Takeshima S, Sano S et al. Gastric duplication cyst: evaluation by endoscopic ultrasonography and magnetic resonance imaging. J Gastroenterol. 1996;31(3):420-4.

Seijo Ríos S, Lariño Noia J, Abdulkader Nallib I, Lozano León A, Vieites Pérez-Quintela B, Iglesias García J et al. Adult gastric duplication cyst: diagnosis by endoscopic ultrasound-guided fine-needle aspiration. Rev Esp Enferm Dig. 2008;100(9):586-90.

Napolitano V, Pezzullo AM, Zeppa P, Schettino P, D'Armiento M, Palazzo A et al. Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review. World J Surg Oncol. 2013;11:33.






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