Duodenal Duplication Cyst Research Articles

Duodenal duplication cyst at the second part of the duodenum with congenital duodenal position anomaly completely resected by laparoscopic partial duodenectomy: a case report

BackgroundDuodenal duplication cysts (DDC) are rare duplications of the alimentary tract. Their treatment depends on their size and location. A radical treatment is total resection, if possible. However, partial excision, puncture, and marsupialization can be selected to prevent surgical injury to the pancreaticobiliary tract despite the risk of recurrence. There are some reports of pancreaticoduodenectomy for DDC because of the risk of recurrent symptoms and malignancy. However, this is considered excessively invasive for DDC, particularly in pediatric cases, because of its extremely low rate of malignancy and high morbidity and mortality rates. We encountered a case of DDC with a congenital duodenal position anomaly occurring in the second part of the duodenum. Taking advantage of the congenital duodenal position anomaly, the DDC was completely resected without injuring the pancreaticobiliary duct.Case presentationA 6-year-old boy was diagnosed with a duodenal duplication cyst with obstruction. There was a congenital duodenal position anomaly. The distal second part of the duodenum was the dorsal side of the proximal second part of the duodenum and ascended upward from the proximal second part of the duodenum. The third and fourth parts of the duodenum ran downward to the left and posterior parts of the portal vein, forming the ligament of Treitz. Complete laparoscopic resection of the duodenal duplication cyst and the second to fourth parts of the duodenum, and duodenojejunostomy with retrocolic reconstruction was performed because the duodenum was easily mobilized to the ligament of Treitz owing to the duodenal position anomaly. The duodenojejunostomy with retrocolic reconstruction achieved a more physiologically normal appearance compared to what would have been achieved with a Roux-en-Y reconstruction. The patient was discharged on postoperative day 12 without any complications.ConclusionsThe procedure used in this case might not be easily applied in all laparoscopy cases. However, it could be an option for duodenal duplication cysts with congenital duodenal position anomalies.

Duodenal Duplication Cyst Masquerading as Metastatic Nonseminomatous Germ Cell Tumor

Testicular cancer can result in retroperitoneal metastatic disease, requiring further intervention with chemotherapy and/or surgical resection. We present the case of a large retroperitoneal mass concerning for metastasis resulting in the identification of a duodenal duplication cyst rather than metastatic disease.

Robotic transduodenal excision of periampullary duodenal duplication cyst in an 11-year-old girl

Robotic transduodenal excision of periampullary duodenal duplication cyst in an 11-year-old girl

Delayed diagnosis of duodenal duplication cyst in a child with recurrent pancreatitis operated by Whipple procedure: a case report.

The authors present the case of a 12-year-old Arab male who was admitted to our hospital with worsening, severe epigastric pain, stabbing in nature, and radiating to the back, suggestive of acute pancreatitis. Serum lipase levels were significantly elevated. The patient received appropriate care. His medical history is notable for multiple bouts of pancreatitis in the last 18 months. Previous investigations at other hospitals were mostly unrevealing. A more extensive workup was performed, revealing a duodenal cystic structure. This led to the diagnosis of a duodenal duplication cyst. The Whipple procedure was decided upon due to his recurrent pancreatitis, which caused fibrotic adhesions and anatomic region distortion. The patient underwent surgery and recovered uneventfully. Acute pancreatitis in children is frequent and can be caused by unrecognized duodenal duplication cysts. When symptomatic, the majority present with vague abdominal pain. Despite using ultrasound as an adjunctive for diagnosis, the cyst might not become apparent until the condition has progressed to an advanced stage. A delayed diagnosis may result in complications necessitating risky surgeries. Children with recurrent pancreatitis should be evaluated for a duodenal duplication cyst. Early use of computed tomography scans may be necessary to identify the cause and spare the patient from risky procedures like Whipple surgery.

Laparoscopic Approach for the Management of Duodenal Duplication

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.

Diagnostics and surgical management of periampullary duodenal duplication cysts in children: a report of cases

BACKGROUND: Obstructive variants of chronic duodenal obstruction may be caused by congenital malformations, such as rare periampullary duodenal duplication cysts. This localization of gastrointestinal duplications is the rarest and is not described in the domestic literature.
 AIM: This study aimed to present the experience of the management of periampullary duodenal duplication cysts in children.
 CASES REPORT: Seven children with periampullary duodenal duplication cysts underwent surgery between 2007 and 2022. All patients suffered from prolonged abdominal pain, vomiting of food, and bile. Two children had recurrent pancreatitis, and one child underwent repeated operations for high intestinal obstruction and biliary obstruction in other hospitals. An abdominal cyst was suspected in one patient at another hospital, and the child underwent exploratory laparoscopy, but no formation was found. Ultrasound, gastroduodenoscopy, computed tomography, and magnetic resonance imaging were performed on these children. Ultrasound examination showed a peristaltic cystic formation up to 4 cm in diameter with a double wall. Gastroduodenoscopy showed formation in the second portion of the duodenum in the region of the major duodenal papilla. This formation covers the intestinal lumen by two-thirds and up to nearly complete obturation. The relationship between duodenal duplication and the bile and pancreatic ducts was clarified on magnetic resonance cholangiopancreatography: the relationship was suspected in two children. All patients underwent wide transduodenal excision of periampullary duodenal duplication cyst; in four cases, laparoscopic access was used. No intra- and postoperative complications occurred. Histological examination revealed true duplications in all cases. The children were discharged on days 1112. In the follow-up after 3 months and 10 years, no complications were noted.
 CONCLUSIONS: Periampullary duodenal duplication cysts can be a cause of chronic duodenal obstruction. Transduodenal excision of periampullary duodenal duplication cysts is the optimal treatment, and this operation can be performed laparoscopically.

A19-year-old female patient with acute pancreatitis of unusual cause

We report the case of a19-year-old woman with abdominal pain and diarrhea. The diagnosis of acute pancreatitis could be made clinically and through laboratory tests. The cause was aduodenal duplication cyst in the area of the papilla, which was initially relieved endoscopically. Once the acute inflammation had healed, the cyst was resected endoscopically to prevent recurrence and the increased risk of malignancy. Duodenal duplication cysts in the papillary area are avery rare (congenital) cause of acute pancreatitis. If acyst is present in the area of the duodenal wall, however, this differential diagnosis should be considered. Resection is indicated for therapy.

Anatomical Diseases Caused by Congenital Duodenal Abnormalities

Disorders of duodenal anatomy are rare and originate during the early embryological development of the foregut. These disorders are associated with significant morbidity in children; however, they may remain undetected during childhood and present during adolescence or adulthood. Duodenal atresia or web, annular pancreas, Ladd’s bands associated with midgut volvulus, and preduodenal portal vein represent duodenal anomalies that may cause partial or complete duodenal obstruction. Duodenal atresia and web occur secondary to incomplete recanalization of the duodenal lumen during the 8th to 10th week of gestation. These anomalies usually require surgical correction; however, the role of endoscopic interventions using innovative equipment is being investigated. Duodenal duplication cysts are an extremely rare congenital anomaly. Most abut the second or third portion of the duodenum and histologically show the normal duodenal wall layers. These lesions clinically present with abdominal pain, weight loss, vomiting, pancreatitis, or features of biliary tract obstruction. Imaging studies including transabdominal ultrasonography, computed tomography, MRI, and endoscopic ultrasonography are useful for detection of the cystic structure. Surgery is the conventional therapeutic modality used for management of duodenal duplication cysts; however, marsupialization (endoscopic intervention to establish communication between the cyst cavity and the duodenal lumen to facilitate duodenal drainage of cystic contents) is increasingly being performed in clinical practice. Duodenum inversum and duodenal diverticula are congenital duodenal disorders that require endoscopic or surgical management in symptomatic patients.

Endoscopic hybrid resection and under-water snare resection of symptomatic duodenal duplication cysts in children.

Duodenal duplication cysts are rare congenital malformations of the gastrointestinal tract, manifested in early childhood [1] [2]. They are benign lesions, although a few cases have been reported including carcinoid tumors, squamous cell carcinomas, and adenocarcinomas [3]. Endoscopic treatments include fenestration, marsupialization, snare resection, and aspiration [4] [5].

S2808 Diagnostic Dilemma: Utilizing Endoscopic Ultrasound (EUS) Guided Biopsy to Assist With the Diagnosis of the Duodenal Duplication Cyst

Introduction: Duodenal duplication cyst (DDC) is a rare congenital anomaly that often presents in the neonatal period with presentations later in life less common. Duplication cysts can develop anywhere from the mouth to the anus with only 4-12% are located in the duodenum. DDC is an uncommon cause of acute pancreatitis but the diagnosis is difficult to make in adults because the symptoms are non-specific. We present a case of diagnostic dilemma of a 53 years old female patient with recurrent acute pancreatitis (RAP), attributed to DDC. Case Description/Methods: Her first index episode of pancreatitis was 12 years prior to her presentation. Patient was found to have a large cyst in the 2nd portion of the duodenum that appeared to be separate from the biliary tree and pancreas on EGD (Figure a), EUS (Figure b) and MRI (Figure c), abutting the major papilla. The initial EUS showed a 20 mm x 13.4 mm anechoic cyst with layering and debris seen in the cavity. Aspiration of the cyst was performing, returning with elevated CEA at 817 ng/mL. No features of chronic pancreatitis were seen. Given elevated CEA, there was a concern for mucinous cyst, prompting a repeat EUS. EUS guided biopsy of the internal cyst wall was performed and histology was consistent with small bowel suggestive of a duplication cyst. Discussion: Our patient presented with recurrent episodes of pancreatitis that could be explained by the intermittent occlusion of the pancreatic duct by debris and sludge found within the cyst. The elevated CEA and inconclusive radiographic results initially suggested possible mucinous cyst, presenting a diagnostic dilemma. Therefore, EUS guided biopsies were essential to confirm the diagnosis and allowing for further endoscopic management. The presence of a smooth muscle coat is absolutely essential for the diagnosis of a duplication cyst which was the case for our patient. DDC are covered both inside and outside by duodenal mucosa containing a distinct layer of smooth muscle. Given its malignancy potential, resection of these cysts is indicated. Endoscopic resection is minimally invasive and has been proposed as an alternative to surgery in selected patients especially given the close proximity of major papilla. Resection techniques using standard polypectomy, or large incision of the roof of the duplication cyst has been discussed in the literature. In our case, endoloop was applied around the base of the cyst, leading to strangulation and necrosis for obliteration of the cyst.Figure 1.: (a) shows a large cyst in the 2nd portion of the duodenum that appeared to be separate from the biliary tree and pancreas on EGD abutting the major papilla, (b) shows the cysts on EUS and (c) shows the cyst on MRI.

S366 Endoscopic Marsupialization of a Large Duodenal Duplication Cyst

Introduction: Duodenal duplication cysts are rare congenital malformations of the gastrointestinal tract. These malformations are usually diagnosed in infancy and childhood. Only one-third of adults are diagnosed after twenty years of age. Presenting symptoms and signs include abdominal pain and intestinal obstruction. These are generally found in the first and second parts of the duodenum. Although the majority are benign, case reports have demonstrated a risk of malignancy. The ideal treatment is complete surgical resection. Due to the proximity of structures including the biliopancreatic ducts, excision of the duodenal duplication cyst may require total pancreaticoduodenectomy. Advances in therapeutic endoscopy provide an alternative option for patients who are at a high risk of surgical complications. Endoscopic marsupialization is a management option in which the cyst cavity contents are drained into the duodenum. Complications include duodenal perforation and bleeding. However, the overall morbidity is low. Endoscopic surveillance is recommended in these patients to assess for recurrence. Case Description/Methods: We present a case of a 38-year-old female who was diagnosed with a large duodenal mass in the second part of the duodenum measuring 8 cm in the largest diameter. This was found incidentally during an upper endoscopy which was performed in July 2020 for hematemesis. The duodenal mass was cystic in appearance on cross-sectional imaging. She was offered endoscopic marsupialization in October 2020 due to morbid obesity which increased the risk of perioperative complications. Discussion: The procedure was performed successfully. Pathology from the lateral wall of the duodenal cyst was consistent with a duodenal duplication cyst. There were no early or delayed complications. The patient had a follow-up endoscopy one year later which did not demonstrate evidence of recurrence on biopsies. Watch the video at https://tinyurl.com/ACGAbstractS366

Intestinal malrotation with concurrent duodenal duplication cyst in a 1-day-old infant

Congenital intestinal malrotation and duodenal duplication cysts are congenital anomalies that are present during the neonatal period. The presence of both in a single patient is exceedingly rare with limited similar case reports present in the literature. We present the case of a neonate diagnosed with a right-sided ovarian cyst in utero, who was later found to have a concurrent duodenal duplication cyst and intestinal malrotation. Treatment consisted of open Ladd's procedure, resection of duplication cyst, and primary duodenoduodenostomy. The report serves as a data point for this rare phenomenon as well as provides surgical options for similar cases.

Relapsing pancreatitis caused by a duodenal duplication cyst communicating to an aberrant pancreatic duct in a girl.

Wang and colleagues report a rare anatomic anomaly consisting of an accessory pancreatic lobe which originated from the main pancreatic gland with duodenal duplication in a girl with relapsing pancreatitis. The anomaly was visualized on magnetic resonance cholangiopancreatography before being confirmed on endoscopic retrograde cholangiopancreatography and surgery.

Large intrahepatic duodenal duplication cyst with a preduodenal portal vein

Duodenal duplication cyst is rarely located inside the liver. We present an extremely rare case of a 12-year-old girl with a large intrahepatic duodenal duplication cyst and a preduodenal portal vein. She was incidentally diagnosed with a large liver cyst (6.5 × 6.1 × 3.6 cm) containing air and fluid with a preduodenal portal vein after a systemic computed tomography scan for suspected internal injuries because of a traffic accident. The upper gastrointestinal series revealed that the cyst communicated with the duodenal bulb via a wide stalk. Upper gastrointestinal endoscopy revealed a large entry hole to the cyst at the duodenal bulb. Biopsy of the inner surface of the cyst revealed that the alimentary mucosa resembled that of the duodenum. She had no symptoms; therefore, continued observation was recommended as the sole management option. This is the third case of this extremely rare condition reported in the literature. This report describes and compares the common features of the three cases. • Duodenal duplication cyst is rarely located inside the liver. • A girl had a large intrahepatic duodenal duplication cyst and preduodenal portal vein. • Only three cases of intrahepatic duodenal duplication cysts have been reported. • There are some common features between these cases. • These features should serve as identification patterns.

Variety Of Gastrointestinal Duplications In Children: Experience At Tertiary Care Hospital.

Gastrointestinal duplication is a rare developmental anomaly that can be present anywhere along the GI tract, most often being found in ileum. The purpose of this study is to share our experience in evaluation of the presentation, investigations, management challenges and complications of patients with this very rare condition. This descriptive case series was conducted at the Department of Paediatric Surgery, National Institute of Child Health Karachi, Pakistan, from April 2018 to October 2019. Data was analysed with regard to age, clinical presentation, investigations, surgical procedures, site and type of lesion, histopathology, complications and outcomes. A total of five patients were managed in one and half year. The patients' ages ranged from antenatally diagnosed foetus to 12 years old child. New-born who presented with antenatal diagnosis of abdominal cyst turned out to have duodenal duplication cyst. Among other four were thoracoabdominal duplication cyst, gastric duplication, jejunal duplication and ileal duplication, last two presented with perforation. Other presentations were abdominal pain, swelling and vomiting. Diagnosis was made on clinical ground, x-ray of abdomen, ultrasound and computed tomography. All cysts were resected successfully and patients remained asymptomatic till one year follow up except one patient who expired postoperatively due to liver failure. Enteric duplication can present in variety of ways depending on anatomical location. Prompt diagnosis and complete excision of cyst is the aim of treatment. However, these rare types of duplication are a challenge to operating surgeons.

Duodenal Duplication Cyst in adult male; An Extremely Rare Entity and a Diagnostic Pitfall leading to Whipple procedure

Abstract Introduction/Objective Whipple procedure is a complex, invasive operation and has high morbidity and mortality. It is the most commonly indicated treatment for treating malignant tumors, however, it can be also used for benign entities as well including biliary stricture, chronic pancreatitis, choledochal cyst, inflammatory pseudotumour, and duodenal angiodysplasia. Methods/Case Report We report a case of a 50-year-old man who presented with symptoms of gastric outlet obstruction. Esophagogastroduodenoscopy and CT scan showed an obstruction at the level of the second part of the duodenum with proximal dilation. Subsequently, a Whipple procedure was performed based on high clinical suspicion of duodenal cancer. Gross examination revealed a unilocular thick walled cyst (4.2 cm) in the duodenum. Histopathologic examination showed a cyst lined by duodenal mucosa with thick smooth muscle wall and focal ectopic gastric tissue. This was finally diagnosed as a duodenal cyst consistent with duplication cyst. Results (if a Case Study enter NA) NA Conclusion Duplication cysts are rare congenital abnormality predominantly diagnosed in infancy and childhood. They are most commonly located in the distal ileum, followed by the esophagus and ileocecal region, and are extremely rare in duodenum. Differential diagnosis includes choledochocele, pancreatic pseudocyst, and cystic tumors of the pancreas, mesenteric cysts, and duodenal diverticulums. Treatment options include total excision, cystojejunostomy, and endoscopic marsupialization but occasionally may lead to more invasive measures such as the Whipple procedure. Although duodenal duplication cysts can have variable clinical presentation and radiological findings, making preoperative diagnosis very challenging, it is still pertinent to be aware of this entity for the optimal patient care.

S3626 First Reported Case Utilizing EUS-Guided Biopsy to Assist With the Diagnosis of the Duodenal Duplication Cyst

S3626 First Reported Case Utilizing EUS-Guided Biopsy to Assist With the Diagnosis of the Duodenal Duplication Cyst

Unroofing and argon mucosal remnant ablation of neonatal duodenal duplication cyst

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.

WHAT DO WE KNOW ABOUT ALIMENTARY TRACT DUPLICATIONS IN CATS?

O presente trabalho trata-se de uma revisão de escopo de duplicações de trato gastrointestinal em gatos. Os critérios de inclusão foram determinados pela revisão de relatos de caso de duplicações gastrointestinais confirmadas por exame histopatológico, incluindo-se também neste trabalho um caso de um felino diagnosticado com duplicação cística duodenal em nossa instituição. Treze casos de duplicações gastrointestinais foram analisados, sendo que um animal possuía uma duplicação bifocal, totalizando, portanto, quatorze duplicações. As variáveis consideradas foram idade, sexo, raça, sintomatologia, localização anatômica, morfologia, presença de comunicação luminal, progressão para malignidade e recorrência. Aproximadamente 62% (n=8/13) dos gatos afetados apresentavam entre 4 meses a 2 anos de idade. Não foi observada predisposição quanto ao sexo, enquanto raça e sintomatologia variaram. Duplicações duodenais corresponderam a 36% (n=5/14). Duplicações císticas sem comunicação luminal 93% (n=13/14). Uma duplicação evoluiu para neoplasia e a recorrência de duplicações gastrointestinais entre os gatos foi de 15% (n=2/13). Evolução para obstrução, hemorragias e malignidade já foram descritas em humanos e gatos como consequência de duplicações gastrointestinais. Considerando a importância e o desafio diagnóstico desta afecção, conclui-se que o clínico veterinário de pequenos animais deve considerar as duplicações de aparelho digestivo no diagnóstico diferencial de gatos jovens com vômitos crônicos e massas císticas intestinais.

EUS diagnosis of asymptomatic type III choledochal cyst.

EUS diagnosis of asymptomatic type III choledochal cyst.