ABSTRACT
Children with acute pancreatitis may experience abdominal pain; the causes of which include anatomical abnormalities and medications. The rare anatomical etiology of duodenal duplication cyst is typically asymptomatic and discovered incidentally. The authors present a unique case of a Whipple-operated duodenal duplication cyst. Case presentation: 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. Discussion: 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. Conclusion: 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.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Duodenal duplication cysts are a rare subtype of alimentary tract duplications cysts, consisting of 7 % of all the duplications. The clinical presentation is variable, depending on the size, location and mass effect. Most duodenal duplication cysts abut the second or third portion of the native duodenum. The standard treatment of choice for symptomatic enteric duplication cysts is complete surgical removal. In our case, by examining the abdomen, ectopic pancreatic tissue was found on the wall of the transverse colon, along with Meckel's diverticulum, 50 cm from the ileocecal junction. CASE PRESENTATION: We present a newborn case presented to the hospital with a history of abdominal mass with jaundice. Abdominal ultrasonography and CT scan show the presence of a cystic mass without specifying its exact source. By opening the abdomen, it was found at the expense of the duodenum, and it was excised and On histopathological analysis, a duodenal duplication cyst was diagnosed. The literature was reviewed and the approach to duodenal duplication cyst in neonates is discussed. CLINICAL DISCUSSION: Duodenal duplication cysts are rare, even so should be taken into consideration when a mass is found. A thorough imaging investigation is crucial in establishing the diagnosis along with histopathology. CONCLUSION: When diagnosing a Duodenal duplication cysts, the cyst must be completely removed because potential risk of malignant transformation.
ABSTRACT
Giardia lamblia is a known etiological factor of a common infectious diarrhea. In rare cases, this parasite was found to be involved in the development of pancreatic and biliary tract diseases, both inflammatory and neoplastic. We present a case of a 64-year-old man known for a duodenal duplication cyst since 2013, with episodes of recurrent acute pancreatitis since 2017. He underwent endoscopic ultrasound-guided fine-needle aspiration of the duplication cyst, with evidence of G. lamblia infection. After treatment of giardiasis and evidence of parasite eradication, the episodes of recurrent acute pancreatitis ceased, following an ex adiuvantibus criterium.
ABSTRACT
BACKGROUND: Duodenal duplication cysts (DDC) are rare congenital anomalies of the gastrointestinal tract and periampullary localization with anatomical variants including biliary and pancreatic duct anomalies remains a surgical challenge. Endoscopic treatment of the periampullary DDC (PDDC) communicating with the pancreaticobiliary duct in an 18-month-old girl is presented to discuss the endoscopic treatment options in children. CASE: An 18-month-old girl with a normal prenatal ultrasound (US) was asymptomatic until complaining of abdominal pain and vomiting at 10-months of age. Abdominal US revealed a 1.8 × 2 cm cystic mass adjacent to the second part of the duodenum. The amylase and lipase levels were slightly increased while she was symptomatic. Magnetic resonance cholangiopancreaticography (MRCP) showed a thick cyst wall measuring 1.5 × 2 cm at the second part of the duodenum, consistent with DDC that was suspected to be communicating with the common bile duct. Upper gastrointestinal endoscopy confirmed a bulging cyst in the duodenum lumen. The puncture and injection of the cyst with contrast material confirmed the communication of the duplication cyst with the common bile duct. The unroofing of the cyst was performed with endoscopic cautery. The biopsy obtained from the cystic mucosa revealed normal intestinal histology. Oral feeding was initiated six hours after the endoscopy. The patient has been followed for the last 8 months uneventfully. CONCLUSIONS: Endoscopic treatment of PDDC with various anatomical variants can be considered an alternative to surgical excision in children.
Subject(s)
Cysts , Duodenal Diseases , Child , Female , Humans , Infant , Duodenum/surgery , Duodenum/abnormalities , Duodenum/pathology , Cysts/pathology , Cysts/surgery , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/surgery , Duodenal Diseases/pathology , EndoscopyABSTRACT
We report the case of a 19-year-old woman with abdominal pain and diarrhea. The diagnosis of acute pancreatitis could be made clinically and through laboratory tests. The cause was a duodenal 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 a very rare (congenital) cause of acute pancreatitis. If a cyst is present in the area of the duodenal wall, however, this differential diagnosis should be considered. Resection is indicated for therapy.
Subject(s)
Cysts , Duodenal Diseases , Pancreatitis , Female , Humans , Young Adult , Adult , Pancreatitis/complications , Acute Disease , Duodenal Diseases/diagnosis , Duodenum/abnormalities , Cysts/diagnosisABSTRACT
Duodenal duplication cysts are a rare subtype of alimentary tract duplications cysts, consisting of 7% of all the duplications. We report a rare case of neonatal duodenal duplication cyst presenting as a palpable abdominal mass and features of gastric outlet obstruction. A 27-day-old male child presented with complaints of icterus, non-bilious vomiting after every feed and right-sided abdominal lump for the last 15 days. A computed tomography scan of the abdomen revealed well-defined peripherally enhancing cystic lesion noted in the subhepatic region extending up to the right lumbar region. On surgical exploration, a cystic mass was found attached to the pyloric part of the stomach along the mesenteric border of the first, second and third part of the duodenum, which was marsupialised, and no communication was found with the duodenum. On histopathological analysis, a duodenal duplication cyst was diagnosed without any heterotopic mucosa. The literature was reviewed and the approach to duodenal duplication cyst in neonates is discussed.
Subject(s)
Cysts , Duodenal Diseases , Duodenum , Humans , Infant, Newborn , Male , Stomach , Tomography, X-Ray ComputedABSTRACT
A duodenal duplication cyst (DDC) is a rare congenital anomaly. Gastrointestinal duplication cysts are traditionally treated by complete surgical resection due to the potential precancerous conditions. Here, we describe an asymptomatic DDC that was successfully treated using endoscopic resection. A submucosal tumor in the descending portion of the duodenum was detected in a 71-year-old female during a regular checkup at our hospital. Upper gastrointestinal endoscopy showed a 10-mm pedunculated submucosal tumor. Endoscopic ultrasonography revealed a 10-mm cystic tumor of low echogenicity that included nodules and debris. Endoscopic resection with hot snare polypectomy was performed for diagnosis and treatment. The postoperative course was uneventful. Histologic examination revealed that the cystic tumor was a DDC. Endoscopic resection is a safe, effective, and minimally invasive alternative to surgical resection for small DDCs with malignant potential.
ABSTRACT
Video 1Ampullary cyst with papillary orifice distal to bulge: not always a choledochocele.
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BACKGROUND: Duodenal duplications are rare congenital anomalies of the gastrointestinal tract. As the periampullary variant is much rarer, literature is scant and only few authors have reported their experience in diagnosis and treatment, particularly with operative endoscopy. CASE SUMARY: To report our experience with the endoscopic treatment in a series of children with periampullary duodenal duplication cysts, focusing on the importance of obtaining an accurate preoperative anatomic assessment of the malformations. The pediatric periampullary duodenal duplication cyst literature is reviewed. We conducted a systematic review according to the PRISMA guidelines. The PubMed database was searched for original studies on "duodenal duplication", "periampullary duplication" or "endoscopic management" published since 1990, involving patients younger than 18 years of age. Eligible study designs were case report, case series and reviews. We analyzed the data and reported the results in table and text. Fifteen eligible articles met the inclusion criteria with 16 patients, and analysis was extended to our additional 4 cases. Median age at diagnosis was 13.5 years. Endoscopic treatment was performed in 10 (50%) patients, with only 2 registered complications. CONCLUSION: Periampullary duodenal duplication cysts in pediatric patients are very rare. Our experience suggests that an accurate preoperative assessment is critical. In the presence of sludge or stones inside the duplication, endoscopic retrograde cholangio-pancreatography is mandatory to demonstrate a communication with the biliary tree. Endoscopic treatment resulted in a safe, minimally invasive and effective treatment. In periampullary duodenal duplication cyst endoscopically treated children, long-term follow-up is still necessary considering the potential malignant transformation at the duplication site.
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We report the finding of a rare diagnosis of a duodenal duplication cyst (DDC) resulting in malignancy. Duplication cysts are rare entities in itself but less than 5% arise from duodenum. Our case represents a rare case, but high suspicion and early resection may have prevented associated complications.
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BACKGROUND: Duodenal duplication cysts are rare gastrointestinal tract malformations. Most patients experience symptom onset in the first decade of life. This review aims to examine clinical presentation, management strategies and outcomes of duodenal duplication cysts in childhood. METHODS: A Pubmed/Medline (http://www.ncbi.nlm.nih.gov/pubmed/) search in October 2019 for articles published since 1999 using the keywords "duodenal duplication cyst," "child" and "newborn" was carried out. Clinical symptoms, complications, diagnostic examinations, treatment options and outcomes were analyzed and tabulated. RESULTS: There were 41 citations in the literature providing adequate descriptions of 45 cases of duodenal duplication cysts. The age of presentation ranged from newborn to 18 years. The median interval between initial presentation and definitive diagnosis and treatment was 17 months (range: 2 months to 12 years). Overall, 67% of cases presented with abdominal pain, and 43% were complicated with pancreatitis. Different surgical and endoscopic therapeutic strategies were reported. CONCLUSIONS: Duodenal duplication cysts may be associated with life-threatening complications and/or recurrent symptoms, impairing quality of life. Early recognition of patients who demonstrate suggestive signs and symptoms is important to ensure success of treatment. This review may be useful to highlight the main diagnostic aspects and limit the risk of a delayed diagnosis.
ABSTRACT
Duodenal duplication cysts are rare congenital anomalies. Duodenal duplication should be considered in the differential diagnosis of patients who present with abdominal symptoms with cystic structures neighboring the duodenum. Here, we present an 8-year-old girl with a duodenal duplication cyst treated with partial cystectomy with mucosal stripping performed laparoscopically. Laparoscopic surgery can be considered as a treatment option for duodenal duplication cysts, especially in extraluminal locations.
Subject(s)
Cysts/surgery , Duodenal Diseases/surgery , Duodenum/surgery , Intestinal Mucosa/surgery , Laparoscopy , Child , Cysts/congenital , Cysts/diagnosis , Duodenal Diseases/congenital , Duodenal Diseases/diagnosis , Duodenum/abnormalities , Duodenum/diagnostic imaging , Female , Humans , Intestinal Mucosa/abnormalities , Intestinal Mucosa/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
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.
ABSTRACT
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.
Subject(s)
Child , Humans , Abdominal Pain , Ampulla of Vater , HemorrhageABSTRACT
A duodenal duplication cyst is rare congenital anomaly, which accounts for 5% of all gastrointestinal duplication cysts. Most of the duodenal duplication cysts are usually found during infancy or early childhood, and present with obstructive symptoms. The most common clinical manifestations are an intestinal obstruction or, less commonly, hemorrhage, perforation, biliary obstruction or pancreatitis. The traditional treatment of a duodenal duplication cyst has been complete surgical resection, but very few cases of endoscopic treatment of a duodenal duplication cyst have been previously reported recently in the literature. Moreover, endoscopic treatment of a duodenal duplication cyst has not been reported in Korea. We report our first experience of a duodenal duplication cyst, including diagnosis and endoscopic management with a detachable snare.
Subject(s)
Diagnosis , Hemorrhage , Intestinal Obstruction , Korea , Ligation , Pancreatitis , SNARE ProteinsABSTRACT
Duodenal duplication cyst is an uncommon congenital anomaly that is usually encountered during infancy or in early childhood. The clinical manifestation is that of duodenal obstruction or, less commonly, obstructive jaundice, acute pancreatitis, or gastrointestinal bleeding. Here, we report a case of duodenal duplication cyst on the juxtapapillary region in a 19-year-old woman with an unusual clinical manifestation of recurrent pancreatitis and peculiar endoscopic finding of the cyst.