Duodenal Duplication Cyst With Enteroliths Diagnosed by Echoendoscopy and Treated by Endoscopic Marsupialization

Abstract

Duodenal duplication cysts (DDC) are rare congenital anomalies primarily occurring during childhood. The duodenum is the site least frequently involved (1). The symptoms of DDC depend on size and location; among adults, they frequently are of an obstructive nature and involve nausea, vomiting, pain, cholestasis, and pancreatitis. In the past, definitive diagnosis and treatment were usually based on a standard surgical approach (2). DDC may contain stones, although this is a very rare presentation (1,3-6). We report the case of a 31-year-old woman with an episode of epigastric pain of strong intensity 9 months ago, accompanied by nausea and vomiting, initially treated as dyspepsia. An abdominal ultrasound revealed cholecystolithiasis and a solid mass in the duodenum (5.0 x 4.9 x 2.6 cm) (FIGURE 1.A). Contrast examination of the duodenum revealed a filling defect occupying almost 90% of the intestinal lumen (FIGURE 1.B) and duodenoscopy revealed

Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management

“…These enteric cysts are especially found in the ileum (33%), esophagus (20%), jejunum (10%), colon (13%), and stomach (2-9%) [ 1 ]. The appendix and duodenum are infrequently involved [ 1 , 68 – 70 ]. A number of 50 cases were also reported as anal canal duplications [ 71 ].…”

“…The patients can be asymptomatic, but if they are diagnosed in the first year of life or early childhood, mostly before the age of 12, abdominal pain, vomiting, weight loss, and even a palpable abdominal mass can be revealed [ 1 , 68 ]. In adults, iron deficiency anemia, bleeding episodes, abdominal pain, nausea, vomiting, pancreatitis, and cholestasis might be the symptoms [ 68 , 70 ].…”

“…These tubulars or spheric malformative structures are attached by the adjacent GI segment and can communicate with the GI lumen or with the appendix or major duodenal papilla [ 9 , 67 , 70 ]. However, communication is not a condition for diagnosis and is not present in up to 80% of the cases [ 1 , 9 , 67 ].…”

“…Inside the cyst, clear fluid is usually found, but bile and enteroliths were observed in duodenal cysts [ 70 , 72 ]. The cystic wall might also incorporate an ectopic pancreas [ 9 ].…”

“…The cystic wall might also incorporate an ectopic pancreas [ 9 ]. Depending on the localization, diameter, associated complications, and the experience of the surgical team, therapy consists of endoscopic removal or marsupialization, excision of the common wall, bypass, or surgical removal of the affected GI segment through laparotomy or laparoscopic methods [ 1 , 9 , 68 , 70 ].…”