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DOI: 10.1055/s-0033-1333640
Pyloroduodenal Duplication Cysts: Treatment of 11 Cases
Publication History
31 October 2012
19 November 2012
Publication Date:
26 February 2013 (online)
![](https://www.thieme-connect.de/media/ejps/201304/lookinside/thumbnails/10.1055-s-0033-1333640-1.jpg)
Abstract
Introduction Abdominal enteric duplications are found in 1 out of 4,500 autopsies, and only 4 to 5% of them are located in the duodenum, where they may be connected with the biliary or pancreatic ducts. The aim of this study was to describe the clinical features, management, and outcome of a large series of duodenal duplication cysts.
Materials and Methods The charts of all patients treated at our institution between 1985 and 2011 were reviewed retrospectively with particular attention to imaging, surgical technique, pathology, and outcome.
Results During that period, 11 cases (81.8% females) were treated. Out of the 11 patients, 8 were symptomatic (vomiting in 3, recurrent acute pancreatitis in 2, and abdominal pain in 3) and 3 were tentatively diagnosed prenatally as choledochal cysts. Median age at surgery was 2.3 years (0 to 13.7) and preoperative diagnosis was correct in five cases. Five cysts were developed intraluminally and three communicated with the biliary duct (one), pancreatic duct (one), or both (one). Surgical treatment consisted of complete resection (four cases, including one pancreaticoduodenectomy), partial removal including all mucosa (four cases), and internal marsupialization (three cases). In all cases, the ductal communications were divided and opened into the duodenal lumen. In six cases, ectopic gastric mucosa was found. All patients recovered uneventfully.
Conclusion Duodenal duplication cysts are rare and may have bizarre anatomical patterns due to biliopancreatic involvement. Optimal treatment is complete surgical removal, and, if this is not possible, partial removal including the mucosa or marsupialization are also good alternatives. In cases with biliary and pancreatic tract connections, these have to be taken down carefully and drained into the duodenum.
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References
- 1 Macpherson RI. Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics 1993; 13 (5) 1063-1080
- 2 Narlawar RS, Rao JR, Karmarkar SJ, Gupta A, Hira P. Sonographic findings in a duodenal duplication cyst. J Clin Ultrasound 2002; 30 (9) 566-568
- 3 Cauchi JA, Buick RG. Duodenal duplication cyst: beware of the lesser sac collection. Pediatr Surg Int 2006; 22 (5) 456-458
- 4 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 (8) 1598-1606
- 5 Laje P, Flake AW, Adzick NS. Prenatal diagnosis and postnatal resection of intraabdominal enteric duplications. J Pediatr Surg 2010; 45 (7) 1554-1558
- 6 Foley PT, Sithasanan N, McEwing R, Lipsett J, Ford WD, Furness M. Enteric duplications presenting as antenatally detected abdominal cysts: is delayed resection appropriate?. J Pediatr Surg 2003; 38 (12) 1810-1813
- 7 Goyert GL, Blitz D, Gibson P , et al. Prenatal diagnosis of duplication cyst of the pylorus. Prenat Diagn 1991; 11 (7) 483-486
- 8 Niehues R, Dietl KH, Bettendorf O, Domschke W, Pohle T. Duodenal duplication cyst mimicking pancreatic cyst in a patient with pancreatitis. Gastrointest Endosc 2005; 62 (1) 190-192
- 9 Redondo-Cerezo E, Pleguezuelo-Díaz J, de Hierro ML , et al. Duodenal duplication cyst and pancreas divisum causing acute pancreatitis in an adult male. World J Gastrointest Endosc 2010; 2 (9) 318-320
- 10 Morley NP, Pyrros AT, Yaghmai V, Miller FH, Nikolaidis P. Biliary dilatation and duodenal intussusception secondary to enteric duplication cyst: MDCT diagnosis. Emerg Radiol 2009; 16 (3) 243-245
- 11 Keller MS, Weber TR, Sotelo-Avila C, Brink DS, Luisiri A. Duodenal duplication cysts: A rare cause of acute pancreatitis in children. Surgery 2001; 130 (1) 112-115
- 12 Wong AM, Wong HF, Cheung YC, Wan YL, Ng KK, Kong MS. Duodenal duplication cyst: MRI features and the role of MR cholangiopancreatography in diagnosis. Pediatr Radiol 2002; 32 (2) 124-125
- 13 Ozel A, Uysal E, Tufaner O, Erturk SM, Yalcin M, Basak M. Duodenal duplication cyst: a rare cause of acute pancreatitis in children. J Clin Ultrasound 2008; 36 (9) 584-586
- 14 Tang SJ, Raman S, Reber HA, Bedford R, Roth BE. Duodenal duplication cyst. Endoscopy 2002; 34 (12) 1028-1029
- 15 Jo YC, Joo KR, Kim DH , et al. Duodenal duplicated cyst manifested by acute pancreatitis and obstructive jaundice in an elderly man. J Korean Med Sci 2004; 19 (4) 604-607
- 16 Tekin F, Ozutemiz O, Ersoz G, Tekesin O. A new endoscopic treatment method for a symptomatic duodenal duplication cyst. Endoscopy 2009; 41 (Suppl. 02) E32-E33
- 17 Arantes V, Nery SR, Starling SV, Albuquerque W, Alberti LR. Duodenal duplication cyst causing acute recurrent pancreatitis, managed curatively by endoscopic marsupialization. Endoscopy 2012; 44 (Suppl 2 UCTN): E117-E118
- 18 Hata H, Hiraoka N, Ojima H, Shimada K, Kosuge T, Shimoda T. Carcinoid tumor arising in a duplication cyst of the duodenum. Pathol Int 2006; 56 (5) 272-278
- 19 Antaki F, Tringali A, Deprez P , et al. A case series of symptomatic intraluminal duodenal duplication cysts: presentation, endoscopic therapy, and long-term outcome (with video). Gastrointest Endosc 2008; 67 (1) 163-168
- 20 Tröbs RB, Hemminghaus M, Cernaianu G, Liermann D. Stone-containing periampullary duodenal duplication cyst with aberrant pancreatic duct. J Pediatr Surg 2009; 44 (1) e33-e35