Abstract
BackgroundDuodenal duplication cyst is an uncommon foregut malformation usually diagnosed at birth or during infancy. Differently from elsewhere, sited small bowel duplications cannot be removed with simple bowel resection, because of the proximity of the biliary and pancreatic ducts also possibly with abnormal course.Case presentationWe report a duodenal duplication cyst in a newborn female requiring early surgery because of nutritional difficulties. The cyst was located adjoined to the second portion of the duodenum sharing part of its muscle wall with the bowel. It was treated by removal of all the esophytic cyst while the remaining mucosa on the common wall with the duodenum was ablated with argon plasma coagulation, preserving the bowel integrity. Early postoperative period was uneventful, and the child could be fed per os on the second day. Yearly follow-up was maintained until 16 years for the risk of recurrence and cancer change due to the incomplete excision. Clinic and echographic controls had always been stayed free from any sequelae.ConclusionsForegut duplications should be removed totally to prevent complications and the long-term risk of cancer, but a duodenal resection can be a harmful surgery in neonatal age. Duplication cysts that are impossible to remove totally can be treated by unroofing and argon plasma coagulation of mucosal surface remnants, avoiding the risks of major procedures also in newborns.
Highlights
Duodenal duplication cyst is an uncommon foregut malformation usually diagnosed at birth or during infancy
We report the case of an outgrown Duodenal duplication cysts (DDC) treated with unroofing and residual mucosa ablation with argon plasma coagulation (APC) in a newborn, whose outcome was evaluated with a long-term follow-up of 16 years
Specimens from the DDC wall confirmed the macroscopic appearance of a bowel wall complete of all the layers lined with normal duodenal mucosa (Fig. 2a); histology of a fragment from the wall treated with APC showed the complete shrinking of the mucosal layer (Fig. 2b)
Summary
The management of intestinal duplications is surgical, and the optimal treatment is the complete primary excision [1, 3]. A decision was taken to avoid endoscopically opening the cyst into the duodenum as, in a newborn patient, it would have been difficult to safely move inside the duodenum abnormally compressed by the cyst and to locate on the duodenal wall shared with the cyst the correct area for the opening, due to the high risk of abdominal perforations. Based on these motivations, we choose to preserve bowel integrity by ablating all the mucosa-lined remnants with the APC technique. The same method could accomplish less invasive endoscopic treatments
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