EUS-Diagnostics of Cystic Duodenal Dystrophy, Case Report

Cystic duodenal dystrophy (CDD) can cause erroneous diagnoses of pancreatic and bile duct cysts.

Aim: to present EUS-possibilities in diagnostics of CDD.

Materials: 29-year old man with the first attack of abdominal pains at the age of 6 years and with periodic attacks of pains since the age of 18 years, always after meals. Decrease in body weight from 113 to 88kg between 2000 and 2009yy when ultrasound showed cysts at the head of the pancreas. Since May 2009 there has been a further decrease in body weight, with fear of food intake, and constant and increasing pain.

In 2010y CT and MRI suspected that these cysts were not in the pancreas, but there were cysts of the bile duct. The patient was referred for EUS to determine the level of the bile duct cysts. EUS was carried out by the radial Olympus echoendoscope GF-UE160 with Aloka device α-10.

Results: The narrowing of the duodenal lumen was shown endoscopically. EUS has revealed a large (up to 4cm) double cyst of a wall of the second part of the duodenum at the border of submucosa and muscularis propria. With preoperative diagnosis “Cystic duodenal dystrophy” the patient was successfully operated on. Cystic duodenal dystrophy was morphologically confirmed. Additionally EUS was carried out on the surgical specimen (ex vivo).

Conclusion: Cystic duodenal dystrophy in some cases can be correctly diagnosed only by EUS.