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CONSEQUENCES OF A DUODENAL DUPLICATION CYST
H Jawa, P Marotta
Division of Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ontario
AIM: Duodenal duplication cyst (DDC) is a rare congenital anomaly usually detected in infancy or childhood. It constitutes about 5% of all gastrointestinal duplications. We present an unusual case of a DDC presenting in an adult patient with recurrent episodes of acute pancreatitis.
METHODS: A 26-year-old man was hospitalized because of recurrent episodes of acute pancreatitis. Cholecystectomy was previously performed; no stones were found. He continued to have episodes despite cholecystectomy. He does not drink alcohol and he is not known to have hyperlipidemia. MRCP suggested the presence of a DDC in the area involving the ampulla. Duodenoscopy showed a very prominent longitudinal fold in the second part of the duodenum in the area of the ampulla. An EUS clearly identified the DDC involving the ampulla. This tubular structure shared the muscularis propria of the duodenal wall. The likely opening of the common bile duct and pancreatic duct are within the duplication cyst. At ERCP, there was a tiny pinpoint opening along this longitudinal fold identified. This small opening was cannulated and contrast filled the duodenal duplication cystic cavity. The opening of this cystic cavity was extended 1-2 cm using a sphincterotome. The cyst was lined with mucosa and bile was seen coming out.
RESULTS: This patient had the common bile duct and the pancreatic duct draining directly into a DDC. This cyst communicated with the lumen by a small opening into the 2nd part of the duodenum and led to intermittent obstruction causing recurrent episodes of acute pancreatitis. Since the successful endoscopic opening and drainage of the cyst into the duodenum, the patient has been feeling well and remained asymptomatic.
CONCLUSION: Duodenal duplication cyst is most often detected in children presenting with intestinal obstruction, intussusceptions, or hemorrhage. Only a few cases of DDC presenting in adults with recurrent pancreatitis were reported in the literature. In our case, the patient was successfully treated by endoscopic cystoduodenostomy. Surgical excision is the usual treatment of duodenal duplications; however endoscopic drainage may be a better option if there is a risk of injury to the pancreatic and bile ducts.