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Prompt preoperative diagnosis of duodenal duplication cyst is uncommon owing to its extreme rarity. The ideal treatment of intestinal duplication cyst is complete surgical excision, though in few cases, due to the proximity to the bilio-pancreatic duct, the complete excision is not possible. We herein present an infant presenting with bilious vomiting starting few days after birth. Ultrasonography and CT scan provided the diagnosis of the duplication cyst in relation to duodenum. A successful surgical management by a subtotal excision was done. Although duodenal duplication is seldom seen, it should be considered in differential diagnoses of upper gastrointestinal tract (GIT) occlusion.

Duodenal duplication cysts are rare congenital abnormalities. We report the case of a 16 year old female who presented with pancreatitis and duodenal intussusception and was subsequently diagnosed with heterotaxy, malrotation and a duodenal duplication cyst. She underwent open surgical management with successful excision of the cyst. The literature is reviewed and discussed.

Supernumerary ovary is a rare gynecological anomaly and is generally excised due to its potential malignant transformation. We report a case of a patient who was referred for excision of a probable duodenal duplication cyst that was subsequently identified as a paraduodenal supernumerary ovary. Pediatric surgery was consulted on an adolescent patient due to a presumed congenital anomaly of the intestinal tract based on imaging studies.

Highlights • Gastrointestinal tract duplication cysts as congenital malformations. • Duodenal duplication cyst extending into the posterior mediastinum. • It can be misdiagnosed even in surgery., Introduction Duodenal duplication is a rare congenital malformation. Although more frequent in childhood, it is rarely observed in adulthood. Preoperative diagnosis can be difficult. Presentation of case We report a case of 42 year-old woman with duodenal duplication cyst situated in the posterior mediastinum, who was misdiagnosed even after a primary surgery. Detailed diagnostic workup and a second operation was done. Discussion This article discusses the incidence of duodenal duplications, their types and clinical presentations, the radiologic and diagnostic features with different therapeutic options. Conclusion Duodenal and the other intestinal duplication cysts should be considered in the differential diagnosis of oral contrast enhanced intrathoracic lesions in thorocoabdominal computerised tomography imaging.

Duodenal duplication cysts are unusual congenital anomalies. Both intestinal malrotation and duodenal duplication may cause extrinsic duodenal obstruction. We report a case of a 5-month-old boy who presented with signs of duodenal obstruction caused by intestinal malrotation, volvulus and a duodenal duplication cyst.

Duodenal duplication cyst is an extremely rare congenital anomaly usually diagnosed in childhood. However, it may remain asymptomatic for a long period. In adults it usually manifests with symptoms related to complications as pancreatitis, jaundice, or intussusception. We present the radiology findings of a patient with a duodenal intussusception secondary to a duplication cyst. The usefulness of the magnetic resonance (MR) in this case is highlighted.

Duodenal duplication cysts are rare congenital anomalies usually found in children, but rare cases have been described in adults. We report the case of a duodenal duplication cyst in a 54-year-old man who presented with a gastrointestinal obstruction inherent to endoluminal hemorrhage. Diagnosis was evocated by endoscopy. It was confirmed by computed tomography, oesogasto duodenal swallowing and magnetic resonance imaging. Partial cystectomy with mucosal stripping was performed via a midline laparotomy. The patient’s recovery was uneventful. The diagnosis was confirmed by histological examination of the operative specimen. In elderly patients with atypical presentation associated to cystic structures neighboring the duodenum, a high index of suspicion is required to diagnose this rare congenital pathology. Complete excision is the optimal treatment, but in some cases, partial cystectomy or endoscopic procedures can be performed.

ispartof: ENDOSCOPY vol:50 issue:7 pages:E184-E185 ispartof: location:Germany status: published

Duodenal duplication cysts (DDC) are a rare type of enteric duplication. We describe the clinical presentation and laparoscopic management of a 7-year-old boy with a periampullary DDC.We also discuss the embryologic and imaging features that distinguish DDC from choledococele (CC). Careful consideration of the anatomic relationships between the ampulla, common bile duct, and duplication cyst are essential to avoid intraoperative bile duct injury.

Bilious vomiting is a relevant sign in children that requires immediate evaluation and diagnosis. One of the causes is an obstruction of the intestinal tract due to duplication if located distal to the major duodenal papilla of Vater. Most of the duplications involve the jejunum, stomach, and colon. Duodenal duplications are very rare and can have an endoscopic or surgical treatment after diagnosis. We are reporting here a case of duodenal duplication in a 3-month-old male child who presented to us with bilious vomiting. Most of them are associated with other anomalies. Completely isolated duodenal duplication is very rare. Therefore, we tried to review the topic while presenting this rare case report of isolated duodenal duplication cyst.

A four year old boy with a duplicated gall bladder communicating with a duplication cyst of the duodenum is reported for the first time in the literature. It is also reported for the absence of any connection with the biliary system.

Duodenal duplication cysts are rare congenital anomalies that can cause acute pancreatitis. Pancreas divisum is also a congenital anomaly, often discovered incidentally, but is considered a possible cause of acute pancreatitis. We report the case of the combination of both anomalies causing recurrent episodes of acute pancreatitis in a young man. Endoscopic treatment by partial excision of the cyst with a polypectomy snare and sphincterotomy of the minor papilla was successful.

Duodenal duplication cysts are rare congenital malformations of which there is limited literature in the pediatric population. The most common presentation in symptomatic patients is abdominal pain and pancreatitis. We present a case of a 14 year old female that presented with emesis, abdominal pain, weight loss, and admission biochemical profile concerning for acute pancreatitis in conjunction with severe hypochloremic, hypokalemic metabolic alkalosis. Further imaging was highly suggestive of duodeno-duodenal intussusception causing obstruction of the pancreatic duct. Patient was taken emergently to the operating room for exploration. Patient underwent laparoscopic assisted reduction of intussusception and resection of duodenal duplication cyst. Patient tolerated the surgery well, and was able to be discharged home in stable condition soon after. There have been no cases reported in the literature that describe pancreatitis secondary to intussusception of duodenal duplication cyst. When diagnosed early, these patients can be safely managed laparoscopically even in emergent settings.

Jejunogastric intussusception is a rare event following gastrointestinal reconstruction. We present a case report in which jejunogastric intussuception was diagnosed in a child four years after a gastrectomy with jejunogastric reconstruction for duodenal duplication. Prompt diagnosis and emergent resection of any non-viable bowel, and revision to a Roux-En-Y anastomosis with or without pexy of the Roux limb to the colon or Y-limb mesentery appear to be the appropriate treatment for this clinical entity.

BACKGROUND: Duodenal duplication cysts are very rare congenital malformations that usually present in childhood with recurrent pancreatitis, biliary or duodenal obstruction. Overt bleeding in an adult secondary to a duodenal duplication cyst is an exceedingly rare diagnosis. AIMS: We report a case of duodenal duplication causing recurrent gastrointestinal bleeding that was successfully managed with endoscopic excision. METHODS: A detailed review of the case and the literature was undertaken. RESULTS: A 67-year-old lady was referred to the GI clinic with a long history of iron-deficiency anemia since childhood and intermittent melena with unknown etiology. She had multiple upper and lower endoscopic examinations which failed to reveal the etiology of anemia or melena. In September 2016, she had frank melena and an acute hemoglobin drop 70g/L from 99g/L and an urgent upper endoscopy was performed. The endoscopic description was that of two visible lumens at the start of the second part of the duodenum. A culprit lesion was found as an adherent clot on a polypoid protuberance at the distal end of one the lumens. This was managed with Epinephrine injection. A second look endoscopy with transparent hood was performed and demonstrated the ampulla sitting on a septum that separated the true lumen and the lumen of the duodenal duplication cyst. The duodenal duplication cyst was resected in two pieces, during which arterial bleeding was encountered, which was managed with soft coagulation end hemostatic clips. The patient subsequently had no further recurrence of melena and iron deficiency anemia has resolved. Pathology demonstrated a duodenal duplication cyst. CONCLUSIONS: This case represents the successful excision of a duodenal duplication cyst with an atypical presentation, in addition to having both ends of the cyst open, which exhibits a unique endoscopic appearance of a double lumen. FUNDING AGENCIES: None

Duodenal duplication cysts are rare congenital malformations. Most symptomatic cases are diagnosed in children and usually present with obstructive findings or bleeding symptoms. Treatment traditionally involves surgical resection, which can be often difficult because of the close proximity of the cysts to the papilla and bilopancreatic confluence. Endoscopic therapy has been used as an alternative to open surgery in a few selected cases. We report a case with a duodenal duplication cyst containing a brown pigmented stone within the cystic lumen. He was visited because of sudden right upper quadrant abdominal pain. An abdominal computed tomography revealed the presence of a cyst with a stone, which was finally removed by endoscopic resection.

A 35-year-old man presented with the complaint of epigastric discomfort. Gastrointestinal endoscopy and endoscopic ultrasonography revealed a cystic lesion 20 mm in size at the ampulla of Vater. Endoscopic retrograde cholangiopancreatography (ERCP) revealed that the cystic lesion communicated with both the common bile duct and pancreatic duct via the common channel. Choledochocele was ruled out by close examination of the ERCP findings. The cystic lesion was surgically resected. Since histological findings revealed that the mucosa inside the lesion was duodenum-like and contained a layer of smooth muscle, the lesion was diagnosed as a congenital duplication cyst of the duodenum.

Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult as symptoms are largely nonspecific. Clinical presentations include pancreatitis, biliary obstruction, gastrointestinal bleeding from ectopic gastric mucosa, and malignancy. A case of duodenal duplication in a 59-year-old female is presented, and her treatment course is reviewed with description of combined surgical and endoscopic approach to repair, along with a review of historic and current recommendations for management. Traditionally, gastrointestinal duplications have been treated with surgical resection; however, for duodenal duplications, the anatomic proximity to the biliopancreatic ampulla makes surgical management challenging. Recently, advances in endoscopy have improved the clinical success of cystic intraluminal duodenal duplications. Despite these advances, surgical resection is still recommended for extraluminal tubular duplications although combined techniques may be necessary for long tubular duplications. For duodenal duplications, a combined approach of partial excision combined with mucosal stripping may offer advantage.

症例は34歳,女性.突然右胸痛が生じ,徐々に増強するため当院に救急搬送された.胸部単純X線検査では右胸水を認めた.胸部CT検査で縦隔右側に空気を含む腫瘤像と胸水,気胸を認めた. 2年前の胸部単純X線写真で鏡面形成像のある腫瘤像が縦隔右側に認められていた.横隔膜ヘルニアによる嵌頓腸管の穿孔を疑い手術を施行した.開腹すると,十二指腸下行脚後壁より十二指腸と交通のある管状の重複腸管が膵後面の後腹膜を上行し,横隔膜を越えて,後縦隔に向かっていた.引き続いて,右開胸すると,胸部の重複腸管は癌化し穿孔していた.重複腸管を切除し,胸腔ドレナージを施行した. 十二指腸に生じ,横隔膜を越え胸部に及ぶ管状の重複腸管は極めて稀で,さらに本症例のように癌化したものは文献上認められなかった.

Duodenal duplication cyst, prenatal diagnosis and postnatal excision Introduction: Duodenal duplication cysts are rare congenital anomalies, usually originate in the 2 nd -3 rd portion of the duodenum. The prenatal echography diagnosis shows a cyst in the right hypochondrium, and we should perform a differential diagnosis with other pathologies. Prenatal diagnosis will allow a correct and precocious postnatal management. Elective excision is the treatment of election preventing the development of complications. Clinical case: We present a rare case of duplication of the first portion of the duodenum that required precocious excision because obstruction to gastric emptying.

A 39-year-old woman presented with a history of recurrent abdominal pain. She had been hospitalized for mild pancreatitis 3 years ago. Her vital signs were stable, and other tests were normal. Radiography showed a well-defined spherical duodenal mass measuring 3.2 cm × 5.0 cm (Figure 1 [A], white arrows). On endoscopy, the lesion appeared as a submucosal mass immediately anterior to the duodenal papilla (Figure 1 [B]). Endoscopic ultrasonography (US) revealed a double-layered wall, and an inner echogenic and outer hypoechoic layer (Figure 1 [C]). A characteristic finding was the double-wall sign1 for duodenal duplication cyst (DDC) (Figure 1 [C]). This article is protected by copyright. All rights reserved.

Gastrointestinal duplications are rare congenital anomalies. Five percent to 10% of them are found in the duodenum. Traditionally, these lesions are treated surgically using either a laparoscopic or open transduodenal approach. We present the successful endoscopic treatment of a symptomatic duodenal duplication cyst in a 9-year-old girl.

This case report describes a unique variant of a duodenal duplication cyst in an 8-year-old boy who had recurrent episodes of upper abdominal pain. Imaging revealed a stone-containing cyst near the biliaropancreatic ducts and concomitant hydrops of the gallbladder. Open transduodenal marsupialization of the cyst and resection of the inflamed gallbladder were performed. Further episodes of pancreatitis did not occur for a follow-up of 2 years.

A 61-year-old male presented to the hospital with a 5-day history of epigastric pain, vomiting and regurgitation. The physical examination was positive only for upper abdominal tenderness. Laboratory findings were unremarkable.

DOI: 10.4328/JCAM.735 Received: 29.06.2011 Accepted: 14.07.2011 Printed: 01.11.2013 J Clin Anal Med 2013;4(6): 504-5 Corresponding Author: Altan Aydin, Kecioren Egitim ve Arastirma Hastanesi Genel Cerrahi A.D. Ankara, Turkiye. T.: +90 3122135764 GSM: +905304109370 F.: +90 3123569003 E-Mail: altanaydin76@hotmail.com Ozet Duplikasyonlar gastrointestinal sistemin herhangi bir yerinde olusabilen ve nadir gorulen konjenital anomalilerdir. Gastrointestinal trakt icerisinde duplikasyonlara en sik ileumda en az oranda ise duodenumda rastlanir [1]. Duodenumda yerlesim gosterenler ise genellikle duodenumun 1 ve 2.kisminda bulunurlar. Duplikasyon kistleri, hastalarda semptom verdiginde siklikla tercih edilen cerrahi yaklasim total eksizyondur. Asemptomatik hastalar ise takip edilebilirler. Fakat literaturde duplikasyon kistlerinden gelisen malignite vakalari oldugundan dolayi asemptomatik hastalar yakindan takip edilmelidir. Biz de 24 yasindaki bir erkek hastada tespit ettigimiz duodenal duplikasyon kistini literatur esliginde sunmayi amacladik.

Duplication of the duodenum is extremely rare. Including the present case, duodenal duplication in adults has been reported in only 20 cases in Japan. All previously reported cases underwent open surgery, and endoscopic resection has not previously been reported. In this report, we describe a patient in whom a duodenal duplication was endoscopically resectable, demonstrating the usefulness of endoscopic resection for the treatment of this malformation.

INTRODUCTIONDuodenal duplication is a rare congenital malformation. Although more frequent in childhood, it may rarely be observed in adulthood. Pre-operative diagnosis can be difficult.PRESENTATION OF CASEWe report the case of a 52-year-old man with a duodenal duplication cyst, who was misdiagnosed even after a primary surgery. Definitive treatment needed an extensive diagnostic workup and a second delicate operation.DISCUSSIONThis article discusses the incidence of duodenal duplications, their types, their clinical presentations, the radiologic and diagnostic features along with different therapeutic options.CONCLUSIONDuodenal duplication should always be one of the differential diagnoses proposed when approaching upper abdominal cystic formations.

We report the sonographic features of a duodenal duplication cyst containing ectopic pancreatic tissue in a 5-month-old boy who presented with symptoms of partial gastric outlet obstruction. Sonography revealed an anechoic, double-walled, bilobed cystic lesion containing debris in the pyloroduodenal region. There was sound through-transmission but no air or communication with the gastrointestinal tract. Surgical resection and histopathologic examination confirmed a duodenal duplication cyst containing pancreatic tissue.