Rectal duplication cysts are challenging to excise due to their close association with the native rectal wall, making safe identification of the dissection plane difficult. A 13-year-old male presented with abdominal fullness, intermittent severe pain, and decreased appetite, and was found on magnetic resonance imaging to have a 19 x 18 x 12 cm abdominopelvic cystic lesion initially suspected to be a lymphatic malformation. He underwent laparoscopic exploration, which revealed a rectal duplication cyst. During dissection, intermittent transanal endoscopic insufflation with a rigid sigmoidoscope was used to dynamically distinguish the rectum from the cyst wall and guide safe plane identification. Complete laparoscopic excision was achieved without rectal injury or conversion to open surgery. The postoperative course was uncomplicated, and the patient remains asymptomatic without complications at five-year follow-up. Intraoperative rigid sigmoidoscopy with intermittent insufflation is a simple and reproducible adjunct that facilitates identification of the dissection plane and may reduce the risk of rectal injury during laparoscopic excision of pediatric rectal duplication cysts. • Rectal duplication cyst excision is limited by difficult plane identification. • Sigmoidoscopy enables real-time visualization of the rectal lumen. • Endoscopic insufflation improves dissection and reduces rectal injury risk. • Technique is useful in older children where Hegar dilators are limited.
Alturki et al. (Fri,) studied this question.