Abstract
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.
Highlights
Case DiscussionDuodenal duplications in adults are exceedingly rare and their diagnosis remains difficult [1,2,3]
Review of available literature finds that much of our knowledge of gastrointestinal duplications comes from pediatric case series [1, 7,8,9,10,11,12]
Most enteric duplications are identified by the age of two years, with less than thirty percent being diagnosed in adults
Summary
Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult [1,2,3]. The duodenal C-loop was noted to be markedly dilated At this time, two clinical diagnoses were considered. The second possibility was that this finding represented some sort of enteric duplication At this time, an upper endoscopy was performed (Figure 2). Three downstream orifices were found just distal to the biliopancreatic ampulla; these findings were again suggestive of a duodenal duplication. Initial inspection found the second and third portions of the duodenum to be markedly dilated as had been observed on prior imaging (Figures 3(a)-3(b)) with a normal appearing distal jejunum. Following clear delineation of anatomy, the tubular duodenal duplication was fully mobilized and resected (Figure 4(a)). In combining preoperative imaging and intraoperative findings, the final defined anatomy was consistent with that of a tubular duodenal duplication of the third and fourth portions of the duodenum
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