Laparoscopic Approach for the Management of Duodenal Duplication

Abstract

Introduction: Intestinal duplication cysts are rare congenital malformations, mainly found in the midgut that generate nonspecific symptoms. The clinical presentation is mainly with abdominal pain, intestinal obstruction, and digestive bleeding. The open surgical approach is usually performed. We present a case of a 7-year-old patient in whom an effective laparoscopic management was implemented. Materials and Methods: A 7-year-old patient was admitted because of weight loss and frequent emesis. A mass in the mesogastrium was palpated upon physical examination. Imaging studies showed a lesion with cystic content in the first duodenal portion measuring 4.7 × 4.4 × 5.6 cm, suggestive of duodenal duplication cyst causing obstruction of the gastric outlet tract. Nutritional support was performed with total parenteral nutrition for a week and laparoscopic resection was programmed. Using an open technique, insertion of a 5-mm umbilical port and two other ports of equal size in the right iliac fossa and epigastrium was performed. Upon entry into the abdominal cavity, a dilated duodenal bulb and collapsed second and third portions of the duodenum were seen. Pyloroduodenotomy was performed, and dissection of the muscle fibers showed a cystic lesion in the first portion of the duodenum, located between the muscle layer and the mucosa, which was subsequently completely resected and referred to pathology analysis. The procedure was completed without complications, and the postoperative evolution was adequate, with discharge on the fourth postoperative day. Results: There are few reports of management with minimally invasive techniques for intestinal duplications, Galazka et al. performed a retrospective analysis of patients presented with congenital abdominal cystic lesions between 2011 and 2019. Of the 39 cases analyzed, 6 were found to have intestinal duplications, 4 of these underwent surgical management by laparoscopy without reporting complications, but did not report the exact location of the cysts.1 In the case of duodenal duplication, there is a case report of an 8-month-old patient with a prenatal diagnosis who underwent laparoscopic resection dependent on the medial wall of the second duodenal portion, without postoperative complications.2 Conclusions: The accumulation of secretions within the intestinal duplication cyst leads to progressive growth, with compression of adjacent structures producing pain and obstruction. They are rare malformations with nonspecific symptoms that require surgical management to avoid associated complications; enucleation or resection of the lesion are the pillars of treatment. Despite few reports in the literature, it is possible to perform a laparoscopic approach in this type of pathology analysis. This approach allows short recovery times, early initiation of oral intake, and better cosmetic results. No competing financial interests exist. Patient Consent Statement: All attempts have been exhausted in trying to contact the patient, next of kin, and/or parent/guardian for informed consent to publish their information, but consent could not be obtained. Runtime of video: 2 mins 58 secs The video was presented at “XXIV Congreso Colombiano de Cirugía Pediátrica,” March 2023, Rionegro, Colombia. The video was presented at “48th Congreso Semana Quirúrgica Nacional,” November 2022, Cartagena, Colombia.