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Surgery

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General Surgery

Question
142 out of 142
 

What is the probably diagnosis of cyst in a child which is located at and associated with Vertebral Defects?



A Myelocele
B Bronchogenic cyst

C Neurenteric cyst
D Neuroblastoma

Ans. C Neurenteric cyst (REF. SABISTON SURGERY 18TH EDITION PG 1712 CHP 58)

a. Diastematomyelia is division of the spinal cord into two halves by projection of a fibrocartilaginous or bony septum originating from the posterior vertebral body and extending posteriorly.

b. It represents a disorder of neural tube fusion with the persistence of mesodermal tissue from the primitive neurenteric canal acting as the septum.

c. The defect involves the lumbar vertebrae (L1 – L3) in 50% of the cases and tends to be associated with abnormalities of the vertebral bodies, including fusion defects, hemivertebra, hypoplasia, kyphoscoliosis, spina bifida and myelomeningocele.

i. Enteric cysts (duplication cysts) arise from the posterior division of the primitive foregut, which develops into the upper division of the gastrointestinal tract. These cysts are most frequently located in the posterior mediastinum, usually adjacent to the esophagus.

ii. These lesions are composed of smooth muscle with an inner epithelial lining of esophageal, gastric, or intestinal mucosa. When gastric mucosa is present, peptic ulceration with perforation into the esophageal or bronchial lumina may occur, producing hemoptysis or hematemesis.

iii. Usually, enteric cysts have an attachment to the esophagus and may be embedded within the muscularis layer. Symptoms are usually related to compression of the esophagus, leading to obstruction that commonly presents as dysphagia.

iv. When enteric cysts are associated with anomalies of the vertebral column, they are referred to as neuroenteric cysts. Such cysts may be connected to the meninges, or, less frequently, a direct communication with the dural space may exist.

v. In patients with neuroenteric cysts, preoperative evaluation for potential spinal cord involvement is mandatory. The vertebral anomalies associated with this syndrome include spina bifida, hemivertebrae, and a widened neural canal. Treatment is surgical excision, providing a definite histologic diagnosis as well as alleviating symptoms and preventing potential complications.

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