a gastrointestinal duplication is defined as a spherical structure , with a muscular coat lined by a mucous membrane .
they can be found anywhere in the gastrointestinal tract , from the base of the tongue to the anus , most commonly occurring in the ileum ( 35% ) .
gastric duplication cysts are a rare phenomenon and account for only 29% of all gastrointestinal duplications .
the majority is circular , non - communicating and surrounded by a smooth muscular coat .
they can be found anywhere in the stomach , with the majority being located on the greater curvature .
gastric duplication cysts are rarely diagnosed in the adult population and occur more commonly in young children , who may present with symptoms of abdominal pain , gastric outlet obstruction or a palpable abdominal mass [ 2 , 3 ] .
clinically important ectopic tissues can include gastric , duodenal and pancreatic tissues , as demonstrated in our case report .
a 28-year - old female presented to our clinic with a 4-month history of right upper quadrant and epigastric pain exacerbated by food .
the patient also reported increased postprandial fullness followed by multiple episodes of nausea and emesis .
a computerized tomography ( ct ) scan of the abdomen and pelvis showed a large cystic mass within the antrum of the stomach ( fig .
this was confirmed with an esophagogastroduodenoscopy ; however , there was concern that this mass was extending past the pylorus into the duodenum , causing a gastric outlet obstruction .
figure 1:an abdominal ct scan demonstrating a cystic mass within the stomach ( black arrow ) an abdominal ct scan demonstrating a cystic mass within the stomach ( black arrow ) the patient underwent an exploratory laparotomy .
the mass was contained within the gastric antrum and did not involve other visceral or solid organs .
histopathologic examination of the lesion demonstrated a 6-cm cyst with gastric mucosa and well - developed pancreatic tissue , including acinar and ductal elements ( fig .
the cyst lumen was focally lined by duodenal type mucosa and was negative for dysplasia or malignancy . 

figure 2:histological section showing both gastric and duodenal tissues located within the cyst ( a ) , along with pancreatic tissue ( b ) histological section showing both gastric and duodenal tissues located within the cyst ( a ) , along with pancreatic tissue ( b )
. the stomach accounts for 29% of all duplications diagnosed , which is the least common site followed by esophagus colon and ileum .
most cases will occur in females compared to males ( 8:1 ) , with the majority of cases being diagnosed in the pediatric population within the first 3 months of life and rarely after 12 years of age [ 2 , 3 ] .
preoperative workup can include abdominal ultrasound , ct scan , magnetic resonance imaging and more recently endoscopic ultrasound [ 4 , 5 ] .
although gastric duplication cysts are a rare entity , they can present with a multitude of symptoms .
adult patients can present with abdominal pain , nausea , vomiting , dysphagia , dyspepsia , abdominal distention and potentially anemia .
weight loss can also occur secondarily to abdominal pain and distention as seen in our patient .
hemorrhage , perforation , malignancy or complete gastric outlet obstruction can occur based on location or type of ectopic tissue present .
although gastric duplication cysts can be found anywhere in the stomach , the most common location is the distal greater curvature .
they may communicate with the gastric lumen as described in our case ; however , the majority is non - communicating with a cystic configuration [ 1 , 7 ] .
another distinctive feature is that any type of gastrointestinal mucosa can line the cyst . 
both gastric and pancreatic ectopic tissues can be seen , which are the most common and tend to be the most clinically significant , as patients can develop complications , such as bleeding , peptic ulcer disease or pancreatitis .
even more rare are complex duplications , which can present with gastric mucosa and islands of heterotopic tissues such as respiratory , duodenal and pancreatic tissue .
multiple treatment modalities have been reported in the literature including enucleation , formation of cystgastrostomy and even endoscopic removal .
complete excision is recommended not only for symptomatic relief as seen with a gastric outlet obstruction , but also because of the risk of malignant degeneration . though rarely reported ,
there have been at least 14 cases of adenocarcinoma diagnosed in gastric duplication cysts after resection in the english literature . if malignant transformation is suspected , surgical resection is the treatment of choice .
gastric duplication cysts are a rare entity , which can contain various heterotopic tissues , such as duodenal or pancreatic islands . surgical excision should be performed in patients who can tolerate surgery when the cyst is symptomatic or the risk of malignant degeneration is of concern .
gastric duplication cysts should be contained in the list of differentials when evaluating submucosal gastric masses .
verbal and written informed consent was obtained from the patient for publication of this case report and any accompanying images .
a copy of the written consent is available for review by the editor of this journal .
 gastric duplication cysts are an uncommon finding , especially in the adult population . presenting symptoms can be non - specific , but can include abdominal pain , nausea and emesis . in this report , we present a 28-year - old female diagnosed with a communicating gastric cyst with both gastric and duodenal mucosa , along with pancreatic tissue and no evidence of dysplasia or malignancy . the clinical picture , diagnosis and treatment are described and compared to findings in the literature . 
Introduction
Case presentation
Discussion
Conflict of interest statement
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