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A RARE CASE REPORT OF CONSECUTIVE CYST-DIVERTICULUM OF DUODENUM AFTER REDUCTION OF TWO DUODENAL CYSTS IN 1-YEAR-OLD MALE
Risto Simeonov 1, Kamelija Simeonova 2, Martin Angjelov 2, Vladimir Avramovski 3
1 Acibadem Sistina Clinical Hospital, Department of Pediatric Surgery, Skopje, Macedonia
2 Acibadem Sistina Clinical Hospital, Skopje, Macedonia
3 Acibadem Sistina Clinical Hospital, Department of Digestive Surgery, Skopje, Macedonia
Introduction: A duodenal diverticulum is a commonly encountered entity in gastrointestinal pathology with a wide variety of appearances and in fact it represents a second most common location for a diverticulum to form, after the colon itself. These duodenal diverticula (DD) are often found incidentally and rarely require intervention. We present a rare case of duodenal duplication cyst after previous reduction of the duodenal cysts, located in the second portion of the duodenum necessitating surgical correction.
Case presentation: A 1-year-old boy, with CT and RTG previously confirmed, surgically treated and biopsied two duodenal cysts, was referred to our department via pediatrician, due to abdominal difficulties and general weakness. After the initial clinical exam and due to clinical and laboratory tests, imaging investigations such as ultrasound, and computer tomography were indicated. Ultrasound investigation was normal, while CT scan of the abdomen showed cyst mass (48 mm) in duodenum with clearly delineated wall itself. The mass pushed the duodenum medially and gallbladder laterally altogether with portal vein and retroperitoneal towards the liver. Immediate indication for surgical treatment was indicated and the child was operated in General Endo-tracheal anesthesia. With medial laparotomy, with its exploration, a cystdiverticulum located in pylorus was found and a total resection of the cyst was made altogether with omentopexy. 5th postsurgical day an Gastroduodenography was made with no extravasation of the contrast outside of the alimentary tract. Post-operative checkups were regularly done without any pathological findings.
Conclusion: In recent years, surgical management has been restricted to patients with significant complicated sequels, such as perforation, abscess, or fistula formation. The importance of imaging methods are essential towards the right and precise diagnose protocol of the pediatric patients. Adequate management and modern approach to the duplication cyst of the duodenum means multi-disciplinary approach and better outcome for the patients.