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CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 3  |  Page : 118-120

Duodenal duplication cyst masquerading as acute relapsing pancreatitis: A rare presentation


Department of Surgery, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India

Date of Web Publication14-Nov-2016

Correspondence Address:
Ankit Jain
48 Alkapuri, Pratap Nagar, Agra - 282 010, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3846.193987

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  Abstract 

Duodenal duplication cysts are rare congenital abnormalities that are most commonly diagnosed in infancy and childhood. However, in rare cases, the lesion can remain asymptomatic until adulthood. An extremely rare case of a previously healthy young adult patient with recurrent acute pancreatitis, who was diagnosed with a duodenal duplication cyst, is presented. At laparotomy, a duplication cyst measuring 3.8 cm × 2.8 cm was found posteromedial to the 2 nd part of duodenum impinging over the head of pancreas. Cyst was excised. The patient is healthy and asymptomatic 1 year after surgery. The present case illustrates the necessity of considering a duodenal duplication cyst in the differential diagnosis of recurrent acute pancreatitis.

Keywords: Adult, duodenal duplication cyst, pancreatitis, recurrent


How to cite this article:
Singhal J, Jain A, Singh P. Duodenal duplication cyst masquerading as acute relapsing pancreatitis: A rare presentation. Saudi Surg J 2016;4:118-20

How to cite this URL:
Singhal J, Jain A, Singh P. Duodenal duplication cyst masquerading as acute relapsing pancreatitis: A rare presentation. Saudi Surg J [serial online] 2016 [cited 2020 Nov 27];4:118-20. Available from: https://www.saudisurgj.org/text.asp?2016/4/3/118/193987


  Introduction Top


Enteric duplication cyst was first described by Fitz in 1884, and the nature of the disease was defined by Gross in 1953. Duplication cysts may be found at any level from the mouth to the anus and are usually attached intimately to some portions of the gastrointestinal tract. Only 4-12% of these duplications are located in the duodenum. Duplications of the duodenum may be either cystic or tubular and are composed of the muscular wall with a gastrointestinal epithelial lining. Duodenum duplication cysts (DDCs) are difficult to diagnose as the presenting symptoms are nonspecific and are closely related to the type, size, and location of the lesion.

We report a rare case of duodenal duplication with recurrent episodes of acute pancreatitis in an adult patient.


  Case Report Top


A 22-year-old male patient presented to us with complaint of recurrent pain in the epigastrium radiating to back for 1 year. The patient had two similar episodes of epigastric pain in the last 1 year. Abdominal examination revealed epigastric tenderness. Blood counts revealed signs of inflammation (white blood cells 14000 cells/mm 3 ). Biochemical investigations showed increased serum levels of amylase (450 U/L) and lipase (350 U/L). An abdominal computed tomography revealed bulky pancreas with a duplication cyst arising from proximal half of the posteromedial wall of the 2 nd part of duodenum of size 3.8 cm × 2.8 cm [Figure 1]. The patient was managed conservatively and responded well to treatment. After 4 weeks, when pancreatitis subsided, the patient was planned for surgery. On exploration, the cyst was present along the mesenteric border of the 2 nd part of duodenum and impinging upon the head of pancreas [Figure 2]. A duodenotomy was performed, and the duodenal mucosa was incised longitudinally along the cystic lesion, and the lesion carefully dissected from the submucosa taking care of the adjacent structures. The divided duodenal mucosa was closed, followed by closure of duodenotomy. Histopathological examination of the excised cyst segment revealed submucosa, muscularis propria, duodenal epithelial lining, and findings consistent with diagnosis of a DDC. The postoperative course was uneventful, and the patient was discharged 8 days later. On follow-up, the patient was asymptomatic 1 year after surgery.
Figure 1: CT showing duodenal duplication cyst

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Figure 2: Intraoperative view of duodenal duplication cyst

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  Discussion Top


Intestinal duplication cysts are extremely rare congenital malformations of the digestive tract, with an incidence of <1/100,000 live births. To be considered a duplication cyst, they must have an attachment to the native intestinal tract, smooth muscle layer, and intestinal mucosal lining. [1] They are least likely to be located in the duodenum, with an incidence of 2-12%. [2]

Clinical findings of duodenal duplication cysts may be nonspecific, such as mild abdominal pain, or more specific, such as acute or chronic pancreatitis. [3] DDCs could stay silent for many years before they cause any symptom including bowel obstruction, pain, distention, or gastrointestinal bleeding. Bleeding, ulceration, and perforation may occur in the cysts containing ectopic gastric mucosa. [4]

Pancreatitis as a presentation of DDC may be caused by a transitory and mobility-related duodenal obstruction of the major papilla outflow by the cyst, the migration of biliary sludge and/or microstones from the cyst to the biliary tree, as observed in biliary pancreatitis; the communication of the dorsal pancreatic duct with the cystic cavity. [3],[5],[6]

In the present case, the duodenal duplication cyst most probably caused extrinsic compression of the pancreatic duct.

The surgical intervention for duodenal duplication cyst includes complete or partial surgical resection of the cyst depending on the relation to ampulla.

Duodenal duplication cysts are considered as benign clinical lesions, and three cases with malignant transformation were reported. [2] Hence, a long-term follow-up is necessary for patients who had undergone partial resection of a duodenal duplication cyst.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Macpherson RI. Gastrointestinal tract duplications: Clinical, pathologic, etiologic, and radiologic considerations. Radiographics 1993;13:1063-80.  Back to cited text no. 1
    
2.
Chen JJ, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC. Meta-analysis: The clinical features of the duodenal duplication cyst. J Pediatr Surg 2010;45:1598-606.  Back to cited text no. 2
    
3.
Redondo-Cerezo E, Pleguezuelo-Díaz J, de Hierro ML, Macias-Sánchez JF, Ubiña CV, Martín-Rodríguez Mdel M, et al. Duodenal duplication cyst and pancreas divisum causing acute pancreatitis in an adult male. World J Gastrointest Endosc 2010;2:318-20.  Back to cited text no. 3
    
4.
Rubin RB, Saltzman JR, Zawacki JK, Khan A, Swanson R. Duodenal duplication cyst with massive gastrointestinal bleeding. J Clin Gastroenterol 1995;21:72-4.  Back to cited text no. 4
    
5.
Hwang JH, Saunders MD, Rulyak SJ, Shaw S, Nietsch H, Kimmey MB. A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses. Gastrointest Endosc 2005;62:202-8.  Back to cited text no. 5
    
6.
Carbognin G, Guarise A, Biasiutti C, Pagnotta N, Procacci C. Duodenal duplication cyst identified with MRCP. Eur Radiol 2000;10:1277-9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]


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[Pubmed] | [DOI]



 

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