J Korean Med Sci.  2004 Aug;19(4):604-607. 10.3346/jkms.2004.19.4.604.

Duodenal Duplicated Cyst Manifested by Acute Pancreatitis and Obstructive Jaundice in an Elderly Man

• Jo YC
• Joo KR
• Kim DH
• Park JH
• Suh JH
• Kim YM
• Nam CW

• KMID: 2157694
• DOI: http://doi.org/10.3346/jkms.2004.19.4.604

Abstract

A duodenal duplication cyst is an uncommon congenital anomaly that is usually encountered during infancy or in early childhood. Duodenal duplication cysts generally appear on the first or second portion of the duodenum and may cause duodenal obstruction, hemorrhage or pancreatitis. Here, we report a case of a duodenal duplication cyst on the second and third portion of the duodenum in an old aged man with obstructive jaundice and acute pancreatitis, which was treated successfully by a surgical excision.

Keyword

Abnormalities; Duplication Cyst; Duodenum; Pancreatitis; Acute Necrotizing; Jaundice; Obstructive

MeSH Terms

Abnormalities
Aged
*Cysts/complications/diagnosis/pathology
*Duodenal Diseases/complications/diagnosis/pathology
Humans
Jaundice, Obstructive/*etiology
Male
Pancreatitis/*etiology

Figure

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  Fig. 1 Duodenoscopic finding. A huge extrinsic mass causing a luminal obstruction in the proximal second portion of the duodenum, with an intact mucosa.

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  Fig. 2 Computerized tomographic finding. A cystic lesion with a distinct wall in the second-to-third portion of the duodenum (A, B) is shown. The duodenum (closed arrow) is compressed by the cystic lesion and is displaced to the medial side of the lesion (open arrow) (A).

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  Fig. 3 Computerized tomographic finding. Dilated intrahepatic duct (A) and a common bile duct and markedly distended the gallbladder (B) is shown.

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  Fig. 4 Gross finding of the surgical specimen. Segments of the duodenum, duplication cyst, gallbladder and some portions of the pancreas are shown. Resection along the left margin of the cyst (arrow) (A) reveals the inner side of the cystic wall (B). A Kelly is protruding into the duodenum (B).

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  Fig. 5 Microscopic finding of the cyst wall obtained from the septum of the duplicated segment. Mucosal denudation and replacement by granulation tissue are seen. The cyst shares a common muscular layer with the duodenum (bottom) (H&E stain, ×100).

Reference

1. Browning RW. Duodenal duplications. Rev Surg. 1963. 20:226–229.

2. Gross RE, Holcomb GW Jr, Farber S. Duplications of the alimentary tract. Pediatrics. 1952. 9:449–468.

3. Rubin RB, Saltzman JR, Zawacki JK, Khan A, Swanson R. Duodenal duplication cyst with massive gastrointestinal bleeding. J Clin Gastroenterol. 1995. 21:72–74.

4. Wada S, Higashizawa T, Tamada K, Tomiyama T, Ohashi A, Satoh Y, Sugano K, Nagai H. Endoscopic partial resection of a duodenal duplication cyst. Endoscopy. 2001. 33:808–810.

5. Sezgin O, Altiparmak E, Yilmaz U, Saritas U, Sahin B. Endoscopic management of a duodenal duplication cyst associated with biliary obstruction in an adult. J Clin Gastroenterol. 2001. 32:353–355.

6. Falk GL, Young CJ, Parer J. Adenocarcinoma arising in a duodenal duplication cyst: a case report. Aust N Z J Surg. 1991. 61:551–553.

7. Narlawar RS, Rao JR, Karmarkar SJ, Gupta A, Hira P. Sonographic findings in a duodenal duplication cyst. J Clin Ultrasound. 2002. 30:566–568.

8. Zamir G, Gross E, Shmushkevich A, Bar-Ziv J, Durst AL, Jurim O. Duodenal duplication cyst manifested by duodeno-jejunal intussusception and hyperbilirubinemia. J Pediatr Surg. 1999. 34:1297–1299.

9. Arbell D, Lebenthal A, Blashar A, Shmushkevich A, Gross E. Duplication cyst of the duodenum as an unusual cause of massive gastrointestinal bleeding in an infant. J Pediatr Surg. 2002. 37:E8.

10. Fan ST, Lau WY, Pang SW. Infarction of a duodenal duplication cyst. Am J Gastroenterol. 1985. 80:337–339.

11. Ogura Y, Kawarada Y, Mizumoto R. Duodenal duplication cyst communicating with an accessory pancreatic duct of Santorini. Hepatogastroenterology. 1998. 45:1613–1618.

12. Richer JP, Faure JP, Maillot N, Silvain C, Levillain P, Carretier M. Duodenal duplication cyst communicating with the bile duct with a long common biliary-pancreatic channel. Eur J Surg. 2000. 166:504–507.

13. Keller MS, Weber TR, Sotelo-Avila C, Brink DS, Luisiri A. Duodenal duplication cysts: A rare cause of acute pancreatitis in children. Surgery. 2001. 130:112–115.

14. Reinus FZ, Weingarten G. Choledochocele of the common bile duct. Am J Surg. 1976. 132:646–648.