Enteric Duplication cysts (EDCs) are uncommon congenital anomalies of the alimentary tract. These can arise from anywhere along the gut including the foregut, midgut and hindgut duplications with most common location being ileum. Majority of the EDCs are symptomatic within the first 2 years of life and early surgery is the treatment of choice for symptomatic EDCs. Radiologically, gut signature sign is pathognomonic on the ultrasound for the more common (80%) cystic/spherical EDCs. However, the less common (20%) tubular subtype can be difficult to interpret on imaging and mimics other pathologies. We present an atypical case of a long tubular duplication cyst in an infant that posed imaging diagnostic challenge. An 8 week old female child presented with fresh red blood in stools, intermittent drawing up of legs and tachycardia with low dropping haemoglobin levels. Intussusception was suspected clinically and ultrasound was initially performed which showed a grossly dilated (up to 4 cm diameter) small bowel loop in left abdomen with mild wall thickening and hyperemia. Rest of the bowel was normal. Incidentally, gall bladder duplication was noted. Subsequently, CT was also performed to delineate the full extent of the abnormality which demonstrated similar findings of a very long segment of dilated jejunal loop with features of enteritis and possibility of congenital segmental intestinal dilatation was considered. Surgery revealed that the dilated bowel loop was in fact a tubular EDC intimately associated with a long segment of jejunum approx. 45 cm in length and complete resection with end to end anastomosis was done. Our case highlights that the tubular subtype of enteric duplications cysts is a rare entity that poses a diagnostic challenge and must be included as plausible differential diagnosis in the appropriate clinical setting and supporting imaging features. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Ng Evonne, Dawani Anuradha

Keywords: Abdominal Imaging, Bowel, Enteric Cyst

Bezoars are an uncommon cause of small bowel obstruction (SBO) in children. Trichobezoars are typically seen in adolescent girls who swallow their hair. Lactobezoars are another unusual cause of intestinal obstruction in neonates/infants. Phytobezoars, foreign body bezoars and pharmacobezoars are other types of bezoars. CT is a useful tool in diagnosing the cause of SBO, however, SBO caused by bezoars may not be detected on a CT exam as it presents as faeces like material proximal to the transition point. Ultrasound (US) can help differentiate a bezoar from faeces. The diagnostic signs of a bezoar on US include an echogenic, arc-like surfaced intraluminal mass, strong posterior acoustic shadowing and twinkling artefacts from the front of the mass resulting from the rough hard surface and high acoustic impedance differences within the internal structure of a bezoar. These features are not seen with faecal material. We present two cases of bezoar induced SBO. The first case was a small intestinal trichobezoar in an 11 year old female child who presented with abdominal pain and bilious vomiting since 4 days. US demonstrated dilated small bowel with classic appearances of a bezoar in distal ileum. CT was not done in this instance and patient underwent surgery based on US findings. Same patient was also shown to have a large gastric bezoar on further endoscopic and ultrasound evaluation. Second case was a lactobezoar in a 9 month old infant that presented with copious bilious aspirates in NG tube, post difficult hernia reduction. CT demonstrated acute SBO with transition point at IC junction and faeces like intraluminal material proximal to it. US again showed characteristic appearances of a bezoar thus clinching the diagnosis. First patient underwent extraction via enterotomy and the second patient was treated with fragmentation and milking out. Our cases highlight following learning points: 1. US shows characteristic appearances and improves diagnostic accuracy in conjunction with CT thus helping radiologists to quickly and easily diagnose bezoar. US can also suffice as first line and only imaging investigation needed. 2. Lactobezoar should be kept as a differential for SBO in neonates/infants. 3. In cases of intestinal bezoars, possibility of further proximal/gastric bezoars must be explored. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Dawani Anuradha, Jagani Sumit

Keywords: Abdominal Ultrasound, Bezoar, Diagnostic Accuracy