Imaging Findings of Intraluminal Duodenal Duplication Cyst in a Pediatric Patient.

A 10-year-old girl was admitted with complaints of abdominal discomfort episodes. Physical examination was unremarkable, and laboratory findings were within normal limits, which were as follows: hemoglobin, 13.5 g/dL; white cell count, 6×103/μL; platelet count, 280×103/μL; blood urea nitrogen, 11 mg/dL; creatinine, 0.6 mg/dL; aspartate aminotransferase, 15 U/L; alanine aminotransferase, 17 U/L; alkaline phosphatase, 60 U/L; total bilirubin, 0.5 mg/dL; and amylase, 35 U/L. Abdominal ultrasonography and computed tomography exhibited an intraluminal cyst in the second part of the duodenum (Figures 1A and 1B). The cyst was located distal to the papilla, measuring 13×21×39 mm3. The enhanced and multilayered wall of the cyst, which was identical to the duodenum wall, was well demonstrated on magnetic resonance imaging (Figures 1C and 1D). The imaging revealed a shared medial wall of both the cyst and the duodenum. There was no dilatation of the biliary tree, and the pancreas and gall bladder appeared normal. Based on the imaging findings, a diagnosis of intraluminal duodenal duplication cyst was established. Surgical resection was planned as the treatment of choice. Duodenal duplication cysts are rare congenital anomalies that constitute 2–12% of all gastrointestinal duplication cysts.1Antaki F. Tringali A. Deprez P. Kwan V. Costamagna G. Le Moine O. et al.A case series of symptomatic intraluminal duodenal duplication cysts: presentation, endoscopic therapy, and long-term outcome (with video).Gastrointest Endosc. 2008; 67: 163-168Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 2Chen J.J. Lee H.C. Yeung C.Y. Chan W.T. Jiang C.B. Sheu J.C. Meta-analysis: the clinical features of the duodenal duplication cyst.J Pediatr Surg. 2010; 45: 1598-1606Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar They are located either within the wall or inside the lumen of the duodenum, and are called intraluminal duplication cysts. The typical location of these cysts is the paramesenteric border of the intestine, and they may share muscle layers with the adjacent bowel.2The wall containing smooth muscle is a criterion for differentiating duodenal duplication cysts from other intraluminal cystic lesions of this region, such as a choledochocele.3Law R. Topazian M. Diagnosis and treatment of choledochoceles.Clin Gastroenterol Hepatol. 2014; 12: 196-203Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar Moreover, an intraluminal duplication cyst is located distal to the papilla, whereas a choledochocele is located proximal to the papilla.1Antaki F. Tringali A. Deprez P. Kwan V. Costamagna G. Le Moine O. et al.A case series of symptomatic intraluminal duodenal duplication cysts: presentation, endoscopic therapy, and long-term outcome (with video).Gastrointest Endosc. 2008; 67: 163-168Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar In the present case, based on the imaging findings, including the presence of a clearly defined multilayered wall on ultrasonography, an enhancement pattern identical to that of the duodenal wall, and a location distal to the papilla, the diagnosis of an intraluminal duodenal duplication cyst was established. Treatment options for intraduodenal duplication cysts include complete surgical resection and endoscopic marsupialization in selected cases.1Antaki F. Tringali A. Deprez P. Kwan V. Costamagna G. Le Moine O. et al.A case series of symptomatic intraluminal duodenal duplication cysts: presentation, endoscopic therapy, and long-term outcome (with video).Gastrointest Endosc. 2008; 67: 163-168Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 2Chen J.J. Lee H.C. Yeung C.Y. Chan W.T. Jiang C.B. Sheu J.C. Meta-analysis: the clinical features of the duodenal duplication cyst.J Pediatr Surg. 2010; 45: 1598-1606Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar None declared.