A rare cause of respiratory distress in pediatric palliative care: Thoracic Duplication Cyst

Gastrointestinal duplication cysts are actually rare congenital anomalies that can accompany various anomalies and are most frequently seen in the small intestine. Gastrointestinal duplication may accompany anomalies such as vertebral anomalies, spinal cord malformations. Depending on the location, symptoms such as chest pain, shortness of breath, cough, asthma-like symptoms, hemoptysis, cyanosis, vomiting, difficulty swallowing, weight loss, hematemesis and melena can be observed. To our knowledge, we report a rare case that has not been reported in pediatric palliative care. We present a case operated for diaphragmatic hernia in the neonatal period. A 3-month-old patient with respiratory distress who was followed up in pediatric palliative care was reoperated and pathologically diagnosed as gastrointestinal duplication cyst. Thoracic cysts can have a wide variety of etiology. The correct diagnosis can be made by performing further examinations and appropriate surgery.

Duplication cyst with midgut volvulus in a neonate: an unusual presentation

Incomplete intestinal fixation or malrotation of gut with midgut volvulus is one of the important causes of bilious vomiting in neonates. The incidence of malrotation of gut in population is 4% and that of duplication cyst is 1:4500. Patients with malrotation are prone to develop midgut volvulus due to their narrow mesenteric base demanding urgent surgical intervention. Common associated anomalies are intrinsic duodenal obstruction, internal hernias, caecal volvulus, anorectal malformations and Hirschsprung’s disease. The present case refers to a 4-day-old neonate who presented with malrotation of gut with reverse volvulus and an associated gastrointestinal duplication cyst, which is a rare association with only few reported case reports. After imaging with ultrasound and contrast radiograph, the baby underwent prompt surgical intervention in the form of Ladd’s procedure with resection and anastomosis of jejunal duplication cyst.

An Unusual Lung Mass of Heterotopic Pancreatic Tissue in a Neonate With an Elevated Immunoreactive Trypsinogen on Newborn Screen

We present a case of a neonate with tracheoesophageal fistula and esophageal atresia along with a suspicious lung mass who had a false-positive newborn screen for cystic fibrosis due to an elevated serum immunoreactive trypsinogen with an additionally elevated serum lipase. The infant’s lung mass was found to contain heterotopic pancreatic tissue consisting of acini, ducts, and islet cells, without an associated gastrointestinal duplication cyst. This constellation of congenital abnormalities has not been described in previous literature. Also, this is the first reported case of a neonate with elevated serum pancreatic enzymes in which the underlying etiology was discovered to be heterotopic pancreas.