An unusual cause of abdominal obstruction in a 10-year-old boy successfully treated by endoscopy
Duodenal duplication cysts are congenital anomalies caused by embryonic malformations. They are extremely rare and account for only 4 % of all gastrointestinal (GI) tract duplications. Symptoms mainly occur during the first decade of life .
We report here the case of a 10-year-old boy who developed upper GI obstruction caused by a major acute bleed within a duodenal duplication cyst ([Fig. 1]). He was initially treated with upper GI aspiration with a nasogastric tube.
After a multidisciplinary discussion, we decided to perform an endoscopic marsupialization of the cyst to treat the obstruction and assist with the forthcoming surgery ([Video 1]). After the cyst had been located during an initial upper GI endoscopy, an endoscopic ultrasound (EUS) was performed to clarify the situation. The cyst was found to be 7.4 × 4.4 cm and had both solid and liquid components ([Fig. 2]). It was punctured to confirm the recent bleeding and to enable a guidewire to be placed inside, thereby facilitating the rest of the procedure by making the entry point visible despite the recent bleeding. A colonoscope with a hood was then used to create a large incision on top of the cyst using a DualKnife (Olympus) and following the guidewire. After the inside of the cyst had been penetrated and the liquid component sucked out, a snare was used to remove the remaining clots. The mucosal layer was present only at the bottom of the cyst; only the typical muscular layer was present elsewhere ([Fig. 3]). Coagulation of small bleeding spots was performed with hot biopsy forceps and a double-pigtail stent was placed inside the cyst as there were remaining clots inside. The patient was able to eat the day following the procedure.
Video 1 An unusual cause of abdominal obstruction in a 10-year-old boy successfully treated by endoscopy.
To our knowledge, this is one of the first case reports showing endoscopic marsupialization of a hematic duodenal duplication cyst . This technique was effective and safe and allowed risky emergency surgery to be avoided.
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.
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Artikel online veröffentlicht:
26. Januar 2022
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- 1 Dipasquale V, Barraco P, Faraci S. et al. Duodenal duplication cysts in children: clinical features and current treatment choices. Biomed Hub 2020; 5: 1-13
- 2 Gjeorgjievski M, Manickam P, Ghaith G. et al. Safety and efficacy of endoscopic therapy for nonmalignant duodenal duplication cysts. Medicine (Baltimore) 2016; 95: e3799