Intestinal duplication revealed by posterior reversible encephalopathy syndrome

Abstract

We report a unique case of intestinal duplication detected on posterior reversible encephalopathy syndrome (PRES) in a 13-year-old girl. She was admitted to the pediatric Emergency Department because of generalized seizures. Radiological assessment revealed a large, well-defined, thick-walled cystic lesion in the mid abdomen, suggestive of duplication cyst associated to a PRES. Exploration confirmed the diagnosis of ileal duplication cyst, and the mass was resected. The postoperative course was uneventful. Both hypertension and neurological dysfunction resolved after the mass resection. A followup brain magnetic resonance imaging was performed 9 months later and showed complete resolution of the cerebellar changes. Although extrinsic compression of the retroperitoneal structures has not been reported in the literature as a complication of duplication cyst, we strongly believe that this is the most logical and plausible hypothesis that would explain the pathogenesis of PRES in our patient.

Keywords: Cyst; Hypertension; Ileum; Metoclopramide; Posterior Reversible Encephalopathy Syndrome.

Fig. 1. Radiological assessment. (A) Brain magnetic resonance image showing bilateral, subcortical, white matter on T2 lesions in the frontal and occipital lobes (black arrows), suggesting posterior reversible encephalopathy syndrome. (B) Abdominal magnetic resonance image showing a large well-defined, thick-walled cystic lesion (white arrow).

Fig. 2. A 13 × 6-cm noncomplicated duplication cyst with a common wall with the ileum.